Ducloux Didier, Bourrinet Emmanuelle, Motte Gérard, Chalopin Jean-Marc
Department of Nephrology, Dialysis, and Renal Transplantation, University Hospital, Besançon, France.
Kidney Int. 2003 Sep;64(3):1065-70. doi: 10.1046/j.1523-1755.2003.00155.x.
Epidemiologic studies reported that antiphospholipid antibodies (APAs) were independent predictors of atherosclerotic events. We recently reported a high prevalence of APAs in renal transplant recipients. Nevertheless, the role of APAs on atherosclerotic events has not been prospectively studied in this high-risk population.
Participants in the study were 324 consecutive renal transplant recipients. Patients were enrolled between January 1996 and May 1998 and followed up until June 2002.
The patients were followed for a mean duration of 62 +/- 26 months. Eighty seven (26.8%) patients exhibited APAs. We found a slight, but significant, correlation between total plasma homocysteine (tHcy) concentration and anticardiolipin (ACA) titers (r = 0.26; P = 0.036). Fifty six athersclerotic events (17.2%) occurred in 54 patients. Atherosclerotic events occurred more frequently in patients with APAs (33% vs. 9%; P = 0.0003) and ACAs levels were higher in patients who experienced atherosclerotic events (23.7 +/- 13.1 IU vs. 13.9 +/- 9.4 IU; P = 0.003). APAs were associated with an increased risk of atherosclerotic events (RR, 2.82; 95% CI, 1.17 to 5.31). Cox regression analysis also revealed that age above the median (RR, 5.21; 95% CI, 1.67 to 17.13), a previous history of cardiovascular disease (RR, 3.54; 95% CI, 1.57 to 10.43), hyperhomocysteinemia (RR, 4.01; 95% CI, 1.22 to 14.61), and current smoking (RR, 2.17; 95% CI, 1.01 to 6.72) were risk factors for atherosclerotic events.
The presence of APAs is an independent cardiovascular risk factor in renal transplant recipients. Prevention trials are necessary to assess the efficacy and safety of anticoagulation therapy in transplant patients with APAs.
流行病学研究报告称，抗磷脂抗体（APAs）是动脉粥样硬化事件的独立预测因素。我们最近报告了肾移植受者中APAs的高患病率。然而，在这一高危人群中，APAs对动脉粥样硬化事件的作用尚未得到前瞻性研究。
该研究的参与者为324例连续的肾移植受者。患者于1996年1月至1998年5月入组，并随访至2002年6月。
患者的平均随访时间为62±26个月。87例（26.8%）患者出现APAs。我们发现血浆总同型半胱氨酸（tHcy）浓度与抗心磷脂（ACA）滴度之间存在轻微但显著的相关性（r = 0.26；P = 0.036）。54例患者发生了56次动脉粥样硬化事件（17.2%）。APAs患者发生动脉粥样硬化事件的频率更高（33%对9%；P = 0.0003），发生动脉粥样硬化事件的患者ACA水平更高（23.7±13.1 IU对13.9±9.4 IU；P = 0.003）。APAs与动脉粥样硬化事件风险增加相关（RR，2.82；95%CI，1.17至5.31）。Cox回归分析还显示，年龄高于中位数（RR，5.21；95%CI，1.67至17.13）、既往心血管疾病史（RR，3.54；95%CI，1.57至10.43）、高同型半胱氨酸血症（RR，4.01；95%CI，1.22至14.61）和当前吸烟（RR，2.17；95%CI，1.01至6.72）是动脉粥样硬化事件的危险因素。
APAs的存在是肾移植受者独立的心血管危险因素。有必要进行预防试验，以评估抗凝治疗在伴有APAs的移植患者中的疗效和安全性。
