中国血脂管理指南（基层版2024年）

doi:10.12114/j.issn.1007-9572.2024.0005

摘要/Abstract

摘要： 低密度脂蛋白胆固醇（LDL-C）是动脉粥样硬化性心血管疾病（ASCVD）的致病性危险因素。近几十年来，中国人群的血脂异常患病率不断升高，血脂管理刻不容缓，在基层开展血脂规范管理尤为重要。《中国血脂管理指南（基层版2024年）》简明地推荐LDL-C作为血脂干预的首要靶点，以ASCVD危险分层确定其目标值；推荐在生活方式干预的基础上，以中等强度他汀类药物作为起始药物治疗，必要时联用胆固醇吸收抑制剂或/和前蛋白转化酶枯草溶菌素9抑制剂的达标策略；并就常见特殊人群的血脂管理策略进行了推荐。本指南旨在为基层医生开展血脂管理提供指导，全面提升基层医生的血脂管理水平，推进ASCVD的一级和二级预防工作。

关键词: 动脉粥样硬化, 心血管疾病, 血脂管理, 低密度脂蛋白胆固醇, 基层

Abstract:

Low-density lipoprotein cholesterol (LDL-C) is a pathogenic risk factor for atherosclerotic cardiovascular disease (ASCVD). In recent decades, the prevalence of dyslipidemia in the Chinese population increases continuously, it is urgent to improve blood lipid management in China. It is particularly important to carry out standardized blood lipid management at primary healthcare institutions. The Chinese Guideline for Lipid Management (Primary Care Version 2024) concisely recommends that LDL-C should be the preferred intervention target in lipid management, and the target values of LDL-C should be determined based on ASCVD risk stratification. The present guideline recommends to use moderate-intensity statins at the beginning of treatment on the basis of lifestyle intervention. If the LDL-C target level can not be reached, other lipid-lowering drugs like cholesterol absorption inhibitors or (and) proprotein convertase subtilisin/kexin type 9 inhibitors should be jointly used for the purpose of reaching the target value. The present guideline also provides blood lipid management strategies for special populations. We aim to provide guidance for primary healthcare professionals to carry out blood lipid management, and comprehensively improve their ability on blood lipid management, and thereby improve the primary and secondary prevention of ASCVD in China.

Key words: Atherosclerosis, Cardiovascular disease, Blood lipid management, Low-density lipoprotein cholesterol, Primary healthcare institution

中图分类号:

R 54

中国血脂管理指南修订联合专家委员会. 中国血脂管理指南（基层版2024年）[J]. 中国全科医学, 2024, 27(20): 2429-2436. DOI: 10.12114/j.issn.1007-9572.2024.0005.
Joint Committee on the Chinese Guidelines for Lipid Management. Chinese Guideline for Lipid Management (Primary Care Version 2024)[J]. Chinese General Practice, 2024, 27(20): 2429-2436. DOI: 10.12114/j.issn.1007-9572.2024.0005.

图/表 9

参考文献 34

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分类	TC	LDL-C	HDL-C	TG	非HDL-C
理想水平	—	<2.6	—	—	<3.4
合适水平	<5.2	<3.4	—	<1.7	<4.1
边缘升高	≥5.2且<6.2	≥3.4且<4.1	—	≥1.7且<2.3	≥4.1且<4.9
升高	≥6.2	≥4.1	—	≥2.3	≥4.9
降低	—	—	<1.0	—	—

分类	TC	LDL-C	HDL-C	TG	非HDL-C
理想水平	—	<2.6	—	—	<3.4
合适水平	<5.2	<3.4	—	<1.7	<4.1
边缘升高	≥5.2且<6.2	≥3.4且<4.1	—	≥1.7且<2.3	≥4.1且<4.9
升高	≥6.2	≥4.1	—	≥2.3	≥4.9
降低	—	—	<1.0	—	—

ASCVD风险等级	LDL-C推荐目标值（mmol/L）
低危^a	<3.4^[5]
中、高危^a	<2.6^[6,7]
极高危	<1.8且较基线降低幅度>50%^[8,9,10]
超高危	<1.4且较基线降低幅度>50%^[8,9,10]

ASCVD风险等级	LDL-C推荐目标值（mmol/L）
低危^a	<3.4^[5]
中、高危^a	<2.6^[6,7]
极高危	<1.8且较基线降低幅度>50%^[8,9,10]
超高危	<1.4且较基线降低幅度>50%^[8,9,10]

降胆固醇强度	药物及其剂量
高强度（每日剂量可降低LDL-C≥50%）	阿托伐他汀40~80 mg
高强度（每日剂量可降低LDL-C≥50%）	瑞舒伐他汀20 mg
中等强度（每日剂量可降低LDL-C 25%~<50%）	阿托伐他汀10~20 mg
	瑞舒伐他汀5~10 mg
	氟伐他汀80 mg
	洛伐他汀40 mg
	匹伐他汀1~4 mg
	普伐他汀40 mg
	辛伐他汀20~40 mg
	血脂康1.2 g