Barbagallo C M, Pinto A, Gallo S, Parrinello G, Caputo F, Sparacino V, Cefalù A B, Novo S, Licata G, Notarbartolo A, Averna M R
Department of Internal Medicine, Institute of Internal Medicine and Geriatrics and Institute of Clinical Medicine, University of Palermo, Italy.
Transplantation. 1999 Feb 15;67(3):366-71. doi: 10.1097/00007890-199902150-00005.
Renal transplant recipients have an increased incidence of cardiovascular disease, but less data exist about cerebrovascular atherosclerosis. In this study, we assessed the prevalence of carotid lesions as evaluated by B-mode ultrasonography in a group of renal transplant recipients, and we evaluated univariate and multivariate relationships between common risk factors and plasma lipoproteins and carotid lesions.
Fifty-seven renal transplant recipients and 113 age- and gender-matched controls underwent a complete clinical visit for the evaluation of risk factors present. In all subjects, a blood sample was collected for lipoprotein determination, and an ultrasound high-resolution B-mode imaging examination of the common carotid arteries was performed.
We found that among renal transplant recipients, there was a significantly increased prevalence of subjects with plaque in comparison with controls (24.6% vs. 6.2%, P<0.001). At multiple analysis, carotid lesions were independently associated with age, hypertension, diabetes, smoking habit, and the presence of cardiovascular disease in controls and with age and hypertension in renal transplant recipients. Neither the lipid profile nor the presence of dyslipidemias was related to carotid score in renal transplant recipients, whereas a nonsignificant trend was observed in controls. Finally, in transplant patients, we did not find any association between carotid lesions and high-density lipoprotein subfractions.
Age and hypertension are the main predictors of extracranial cerebrovascular atherosclerosis after renal transplantation. Because carotid lesions may represent a useful predictive marker of clinical events in nontransplant subjects, carotid artery evaluation by B-mode ultrasound might be routinely included in the management of renal transplant patients.
肾移植受者心血管疾病的发病率增加，但关于脑血管动脉粥样硬化的数据较少。在本研究中，我们评估了一组肾移植受者经B型超声检查评估的颈动脉病变患病率，并评估了常见危险因素与血浆脂蛋白和颈动脉病变之间的单变量和多变量关系。
57例肾移植受者和113例年龄及性别匹配的对照者接受了全面的临床检查，以评估存在的危险因素。所有受试者均采集血样进行脂蛋白测定，并对颈总动脉进行超声高分辨率B型成像检查。
我们发现，与对照组相比，肾移植受者中斑块患者的患病率显著增加（24.6%对6.2%，P<0.001）。在多因素分析中，颈动脉病变与对照组的年龄、高血压、糖尿病、吸烟习惯和心血管疾病的存在独立相关，与肾移植受者的年龄和高血压独立相关。肾移植受者的血脂谱和血脂异常的存在均与颈动脉评分无关，而在对照组中观察到无显著趋势。最后，在移植患者中，我们未发现颈动脉病变与高密度脂蛋白亚组分之间存在任何关联。
年龄和高血压是肾移植后颅外脑血管动脉粥样硬化的主要预测因素。由于颈动脉病变可能是非移植受试者临床事件的有用预测标志物，因此在肾移植患者的管理中，可常规进行B型超声颈动脉评估。
