泼尼松撤药对环孢素治疗的肾移植患者新代谢三联征的影响。

Effects of prednisone withdrawal on the new metabolic triad in cyclosporine-treated kidney transplant patients.

作者信息

Lemieux Isabelle, Houde Isabelle, Pascot Agnès, Lachance Jean-Guy, Noël Réal, Radeau Thierry, Després Jean-Pierre, Bergeron Jean

机构信息

Lipid Reseach Center, CHUL Research Center, Ste-Foy, Québec, Canada.

出版信息

Kidney Int. 2002 Nov;62(5):1839-47. doi: 10.1046/j.1523-1755.2002.00611.x.

DOI:10.1046/j.1523-1755.2002.00611.x

PMID:12371987

Abstract

BACKGROUND

Cardiovascular disease is a major cause of morbidity and mortality after renal transplantation. Prednisone (Pred) maintenance therapy is associated with risk factors for atherosclerosis. Therefore, we were interested in quantifying the effects of Pred withdrawal on body weight and waist circumference as well as on metabolic markers of coronary heart disease risk.

METHODS

Twenty-six cyclosporine-treated renal transplant patients (13 men and 13 women) were evaluated before and after at least 11 months (16 +/- 2.9 months) of Pred withdrawal. A complete fasting lipoprotein-lipid profile as well as anthropometric measurements were obtained from each patient.

RESULTS

Pred withdrawal was associated with a 6.0% reduction of body weight (-4.34 +/- 5.40 kg; P < 0.05) and with a 7.7% decrease in waist girth (-7.13 +/- 5.75 cm; P < 0.005) in women, whereas no change in these variables were observed in men. In both genders, plasma low-density lipoprotein (LDL) cholesterol and triglyceride concentrations were unaffected by Pred withdrawal, whereas plasma high-density lipoprotein (HDL) cholesterol levels decreased by 14.0% in women (-0.22 +/- 0.22 mmol/L; P < 0.005) and 22.0% in men (-0.36 +/- 0.28 mmol/L; P < 0.005). Pred withdrawal was associated with a significant reduction in plasma apolipoprotein B concentrations in both women (-0.28 +/- 0.15 g/L; -24.6%; P < 0.0001) and men (-0.22 +/- 0.19 g/L; -20.5%; P < 0.005). A significant reduction in fasting insulin was observed in both women (-27.8 +/- 27.9 pmol/L; -25.3%; P < 0.005) and men (-25.0 +/- 32.8 pmol/L; -21.4%; P < 0.05), whereas the LDL peak particle size was unaffected by Pred withdrawal.

CONCLUSIONS

Pred withdrawal modifies several anthropometric and metabolic cardiovascular risk factors in renal transplant patients. Furthermore, female patients may derive further benefits of Pred withdrawal resulting from the concomitant loss of body weight and abdominal fat.

摘要

背景

心血管疾病是肾移植后发病和死亡的主要原因。泼尼松（Pred）维持治疗与动脉粥样硬化的危险因素相关。因此，我们有兴趣量化停用Pred对体重、腰围以及冠心病风险代谢标志物的影响。

方法

对26例接受环孢素治疗的肾移植患者（13例男性和13例女性）在停用Pred至少11个月（16±2.9个月）前后进行评估。从每位患者处获取完整的空腹脂蛋白-脂质谱以及人体测量数据。

结果

停用Pred后，女性体重下降6.0%（-4.34±5.40kg；P<0.05），腰围减少7.7%（-7.13±5.75cm；P<0.005），而男性这些变量无变化。在两性中，停用Pred对血浆低密度脂蛋白（LDL）胆固醇和甘油三酯浓度无影响，而女性血浆高密度脂蛋白（HDL）胆固醇水平下降14.0%（-0.22±0.22mmol/L；P<0.005），男性下降22.0%（-0.36±0.28mmol/L；P<0.005）。停用Pred与女性（-0.28±0.15g/L；-24.6%；P<0.0001）和男性（-0.22±0.19g/L；-20.5%；P<0.005）血浆载脂蛋白B浓度显著降低相关。女性（-27.8±27.9pmol/L；-25.3%；P<0.005）和男性（-25.0±32.8pmol/L；-21.4%；P<0.05）空腹胰岛素均显著降低，而停用Pred对LDL峰值粒径无影响。