治疗过程的检测

饮食与非调脂药物治疗3～6个月后，应复查血脂水平，如能达到要求即继续进行治疗，但仍需每6个月至1年复查1次，如继续达到要求，每年复查1次。药物治疗开始后4～8周复查血脂及AST、ALT和CK，如达到目标值，逐步改为每6～12个月复查1次，如开始治疗3～6个月血脂复查仍未达到目标值，则调整剂量或药物种类，或联合药物治疗，再经4～8周后复查。达到目标值后延长为每6～12个月复查1次。生活方式治疗和降脂药物治疗必须长期坚持，才能获得临床益处。对心血管病和高危患者，应采取更积极的降脂治疗策略。降脂药物治疗需要个体化，治疗期间必须监测安全性。依据患者的心血管病状况和血脂水平选择药物和起始剂量。在药物治疗时，必须监测不良反应，主要是定期检测肝功能和血CK。如AST或ALT超过正常值上限3倍，应暂停给药。停药后仍需每周复查肝功能，直至恢复正常。在用药过程中应询问患者有无肌痛、肌肉压痛、肌无力、乏力和发热等症状，血CK升高超过正常上限5倍应停药。用药期间如有其他可能引起肌溶解的急性或严重情况，如败血症、创伤、大手术、低血压和抽搐等，应暂停给药。

总的来说，在高脂血症的防治过程中应考虑效果与安全性之间的平衡，以及患者的经济情况和依从性。高脂血症的防治主要是为了降低心血管疾病风险，在强调降脂治疗的同时，不应盲目以增加药物剂量为主要手段，应根据指南推荐，在治疗前根据患者的危险因素、并发症和临床情况进行危险分层。临床医师不仅要坚持强调降脂治疗策略，同时要密切监测降脂治疗的安全性，要鼓励患者坚持非药物治疗。目前我国人群高脂血症的发病率呈上升趋势，尤其是农村富裕地区和经济发达地区。广大医师应加强宣传教育，积极提高规范调脂能力，重视非药物治疗，制订安全、合理、有效的防治策略，在保障患者安全的前提下积极进行降脂治疗，争取获得最大效果。

（胡耀敏）

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