DeNofrio D, Desai S, Rader D J, Chang G, Kelley M P, Acker M A, Loh E
Cardiovascular Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA.
Am Heart J. 2000 Apr;139(4):729-33. doi: 10.1016/s0002-8703(00)90056-5.
Elevated concentrations of lipoprotein(a) have been considered an important risk factor in the development of premature cardiovascular disease and have been proposed as a risk factor in the development of accelerated cardiac allograft vasculopathy after orthotopic heart transplantation.
We prospectively measured lipoprotein(a), fasting cholesterol, and triglyceride concentrations before (n = 38), 6 months (n = 38), and 1 year (n = 21) after orthotopic heart transplantation. The mean age of the patients was 52 +/- 2 years. Eighty-seven percent of the patients were men, 82% were white, and 61% had ischemic cardiomyopathy.
Mean lipoprotein(a) concentration was lower 6 months after transplantation than it was before the operation (23 +/- 3 mg/dL vs 17 +/- 3 mg/dL; P =.014) and remained low 1 year after transplantation (23 +/- 3 mg/dL vs 18 +/- 4 mg/dL; P = not significant). In contrast, mean cholesterol concentration was higher 6 months after transplantation (171 +/- 8 mg/dL vs 221 +/- 8 mg/dL; P <.001) and 1 year (171 +/- 8 mg/dL vs 205 +/- 10 mg/dL; P <.01) than it was before transplantation. Triglyceride concentration was higher 1 year after transplantation than it was before the operation (146 +/- 13 mg/dL vs 184 +/- 20 mg/dL; P =.017).
Lipoprotein(a) concentrations decrease during the 6 months after transplantation and stay low for at least 1 year after the operation. Additional studies are needed to ascertain the effect these changes in lipoprotein(a) concentration on the development of cardiac allograft vasculopathy.
脂蛋白(a)浓度升高被认为是早发性心血管疾病发生的重要危险因素，并且被提出是原位心脏移植后加速性心脏移植血管病变发生的危险因素。
我们前瞻性地测量了原位心脏移植前（n = 38）、移植后6个月（n = 38）和1年（n = 21）时的脂蛋白(a)、空腹胆固醇和甘油三酯浓度。患者的平均年龄为52±2岁。87%的患者为男性，82%为白人，61%患有缺血性心肌病。
移植后6个月时脂蛋白(a)的平均浓度低于手术前（23±3mg/dL对17±3mg/dL；P = 0.014），并且在移植后1年时仍保持较低水平（23±3mg/dL对18±4mg/dL；P无统计学意义）。相比之下，移植后6个月（171±8mg/dL对221±8mg/dL；P < 0.001）和1年（171±8mg/dL对205±10mg/dL；P < 0.01）时的平均胆固醇浓度高于移植前。移植后1年时的甘油三酯浓度高于手术前（146±13mg/dL对184±20mg/dL；P = 0.017）。
脂蛋白(a)浓度在移植后6个月内降低，并且在手术后至少1年内保持较低水平。需要进一步研究以确定脂蛋白(a)浓度的这些变化对心脏移植血管病变发展的影响。
