代谢综合征高血压 发病机制与治疗新策略
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Transcript of 代谢综合征高血压 发病机制与治疗新策略
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(MS),
MSCVD(ASCVD) 2(T2DM) Kashyap SR, DeFronzo RA. The insulin resistance syndrome: physiological considerations. Diabetes Vasc Dis Res, 2007, 4: 13-19.
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1998WHO IGT / IFG, 2 :BP140/90mmHgTG1.7mmol/L HDL-C0.85 BMI>30kg/m2(20g/min): PAI-1
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2002ATPIII
53:>6.1mmol/L(T2DM) 130/85mmHgTG1.65mmol/LHDL-C:
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2005IDF
: 102cm/88cm; 94cm/80cm; 90cm/80cm 42:TG1.65mmol/LHDL-C: 5.6mmol/L,OGTT,
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2004
: BMI25.0kg/m2: BP>140/90mmHg: TG1.65mmol/L/HDL-C:
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MS: TNFNEFA ROS/ROS:
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, . : : HDL LDL/ : -
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: PAI-1 : , : CRPWBC ()
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Bakris GL. Current Perspectives on Hypertension and MetabolicSyndrome. J Manag Care Pharm.2007;13 (5):S3-S5 LDL TG HDLASCVDT2DM
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(MS) 2 CVD (50%) () () () , MS
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MS:WHO140/90mmHgATPIIIIDF130/85mmHg(, )MS140/90mmHg MS,84.2%,76.7%
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MS/ MS:()
/
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1. RAAS RAAS, ,,
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2. (SNS), ; RAAS,
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3. , ,
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4. , NO, , , ,
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1.5 RAAS RAAS, , ,
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6. BMI,, BMI,,
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1.7 , ,
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1.8 FFA, TG, , ,
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,,
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1. 1.1 78%65% (kg)=cm 105(110)
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1.2 , TZDsPI3PI3
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1.3 ,60min/d
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2.
MS, MS, : (TZDs, PPAR ).
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2.1 MS: ; /, CV, TZDs; B(), +, T2DMCV; , MS
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2.2 TZDs()(): PPAR-, T2DM, MI, Nissen24: CV43%, 64%, RECORD: 2001~2008, CV, FDA, ,
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3. ACEI/ARB: :( ) Opie580104: ACEIARBsDM 20% 16% /DM4
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35% 13% 10% -17% -21% -22% -33% -40 -30 -20 -10 0 10 20 30 40
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ARBsPPAR(Benson SC, et al. Hypertension, 2004, 43:993-1002)23 14
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50100150200250300350400 ARBs () 450500
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: PPARmmol/L25201510500.1110100Luciferase (x-fold induction over vehicle treated cells)Circulation, 2004109:2054-2057
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4. MS, 40%~60%
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OGTTMS,IFGOGTTT2DM
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FPG: 48~64%ADA 2003.11 FPG6.1mmol/L5.6mmol/L6.1mmol/L: 64%5.6mmol/L: 48%
FPG,OGTT
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UKPDS, HbA1c1%, DM21%,14%
DM : 5.1~6.1mmol/L 2h: 7.0~7.8mmol/L HbA1c
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MSASCVD ,MS: CHO
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MS-1(PAI-1)
--6hs-CRPACEITZDsCRP