从共识到实践:糖尿病患者血脂管理的未来  

From consensus to practice:the future of lipid management in diabetes mellitus

作　　者：宋建强 谢小洁[1] SONG Jianqiang;XIE Xiaojie(Department of Cardiology,the Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院心内科,杭州310009

出　　处：《心电与循环》2025年第2期118-125,共8页Journal of Electrocardiology and Circulation

基　　金：浙江省“尖兵领雁+X”科技计划项目(2025C02145)。

摘　　要：糖脂代谢属于人体基本代谢过程,糖尿病和血脂异常是动脉粥样硬化性心血管疾病的独立危险因素,在疾病发生、进展中发挥重要作用。糖尿病患者合并血脂异常具有"一高三低"特点(高患病率、低知晓率、低治疗率和低达标率),常导致临床不良结局,因而亟须改变目前管理现状。本文系统阐述糖尿病患者血脂谱异常特点及发生机制,解读相关血脂管理指南变迁和《2024年糖尿病患者血脂管理中国专家共识》,结合临床实践探讨糖尿病患者血脂管理策略、方法和靶标。随着对血脂亚组分指标认识的深入、小分子干预药物临床试验的开展,糖尿病患者血脂管理正迈向精准化时代,有望为进一步降低心血管风险提供新的方向。Glucose and lipid metabolism are essential physiological processes within the human body.Diabetes mellitus and dyslipidemia independently constitute significant risk factors for atherosclerotic cardiovascular disease(ASCVD),contributing substantially to its initiation and progression.Patients with diabetes who also present with dyslipidemia typically demonstrate a distinct profile characterized by"one high and three lows":a high prevalence of the condition,coupled with low levels of awareness,treatment rates,and achievement of therapeutic targets.This profile frequently results in unfavorable clinical outcomes,underscoring the urgent need for enhancements in existing management strategies.This paper provides a comprehensive analysis of the characteristics and mechanisms underlying dyslipidemia in patients with diabetes.It reviews the progression of lipid management guidelines and critically examines the Expert Consensus on the Lipid Management of Diabetic Patients(2024 edition).Additionally,the paper investigates strategies,methodologies,and objectives for lipid management in diabetes within the framework of clinical practice.With advancements in the understanding of novel lipid subfraction indicators and the development of clinical trials for small-molecule interventions,lipid management in diabetes is transitioning into an era of precision medicine.This shift presents new opportunities for further reducing cardiovascular risk.

关 键 词：糖尿病 血脂异常 血脂亚组分 靶值 主要不良心血管事件 

分 类 号：R587.1[医药卫生—内分泌]