作者:Richard Moore、Domingo Hernandez、Hannah Valantine
DOI:10.2165/00002018-200124100-00004
日期:——
Cardiovascular disease is now the leading cause of death in transplant recipients. This is due, in part, to the vulnerability of these patients to a complicated set of conditions including hypertension, diabetes mellitus, and post-transplant hyperlipidaemia (PTHL). PTHL is characterised by persistent elevations in total serum cholesterol, low density lipoprotein cholesterol and triglyceride levels. The causes of PTHL are complex and not fully understood, however several classes of immunosuppressants including the corticosteroids, rapamycins and calcineurin inhibitors, appear to play a role. PTHL has been observed in most studies in which patients received calcineurin inhibitor—based regimens, and has been observed with both tacrolimus and cyclosporin. Comparing these calcineurin inhibitors with regard to the relative incidence or severity of PTHL occurring during treatment is difficult because of the use of higher doses of corticosteroids in cyclosporin-based regimens, as compared with tacrolimus-based regimens. However, current expert opinion suggests that the discrepancies in the relative incidence and severity of PTHL are largely accounted for by this difference in corticosteroid dose. At this point in time, evidence for potential differences is scant and inconclusive. Further study is needed, not only to investigate differences in lipid profile, but also of the relative effects of these immunosuppressants on long term graft function as well as on cardiovascular morbidity and mortality. PTHL can be successfully managed with a combination of dietary management, reduction and, if appropriate, withdrawal of corticosteroids, and the administration of lipid-lowering drugs. With this combination of therapeutic options, the threats to long term health posed by PTHL may be effectively addressed.
心血管疾病目前是导致移植受者死亡的主要原因。部分原因是这些患者容易患上一系列复杂的疾病,包括高血压、糖尿病和移植后高脂血症(PTHL)。PTHL 的特征是血清总胆固醇、低密度脂蛋白胆固醇和甘油三酯水平持续升高。PTHL 的病因复杂,尚未完全明了,但包括皮质类固醇、雷帕霉素和钙神经蛋白抑制剂在内的几类免疫抑制剂似乎在其中发挥了作用。在大多数研究中,患者接受了以钙神经蛋白抑制剂为基础的治疗方案,并在他克莫司和环孢素的治疗中观察到 PTHL。由于环孢素治疗方案与他克莫司治疗方案相比使用了更大剂量的皮质类固醇,因此很难比较这些钙神经蛋白抑制剂在治疗过程中发生 PTHL 的相对发生率或严重程度。不过,目前的专家意见认为,PTHL 的相对发生率和严重程度的差异在很大程度上是由皮质类固醇剂量的差异造成的。目前,有关潜在差异的证据还很少,也没有定论。还需要进一步研究,不仅要研究血脂谱的差异,还要研究这些免疫抑制剂对长期移植物功能以及心血管疾病发病率和死亡率的相对影响。通过饮食管理、减少并酌情停用皮质类固醇以及服用降脂药物,可以成功控制 PTHL。通过这种综合治疗方案,PTHL 对长期健康的威胁可以得到有效解决。