Krämer B K, Böger C, Krüger B, Marienhagen J, Pietrzyk M, Obed A, Paczek L, Mack M, Banas B
Klinik und Poliklinik für Innere Medizin II--Nephrologie, University of Regensburg, Regensburg, Germany.
Transplant Proc. 2005 May;37(4):1868-70. doi: 10.1016/j.transproceed.2005.04.009.
Cardiovascular morbidity, including coronary artery disease and left ventricular hypertrophy, and mortality are high in patients following renal transplantation. Cardiovascular disease is thought to be due to traditional (hypertension, hyperlipidemia, diabetes mellitus and smoking) as well as nontraditional cardiovascular risk factors (microinflammation). Furthermore, immunosuppressive drugs, namely, calcineurin inhibitors, sirolimus, and steroids, have been reported to adversely affect cardiovascular risk factors (e.g., hypertension, hyperlipidemia, hyperglycemia). Evidence from comparative trials and from conversion studies suggest that blood pressure, hyperlipidemia, and hyperglycemia after renal transplantation may be differentially affected by the calcineurin inhibitors cyclosporine and tacrolimus. In the European Tacrolimus versus Cyclosporin A Microemulsion Renal Transplantation Study, 557 patients were randomly allocated to therapy with tacrolimus (n = 286) versus cyclosporine (n = 271). In addition, to blood pressure, serum cholesterol, HDL cholesterol, triglycerides, and blood glucose, we estimated the 10-year risk of coronary heart disease (Framingham risk score). Tacrolimus resulted in a significantly lower time-weighted average of serum cholesterol (P < .001), and mean arterial blood pressure (P < .05), but a higher time-weighted average of blood glucose (P < .01) than cyclosporine. Mean 10-year coronary artery disease risk estimate was significantly lower in men treated with tacrolimus, (10.0% versus 13.2%; P < .01) but was unchanged in women (4.7% versus 7.0%). Tacrolimus and cyclosporine microemulsion have compound-specific effects on cardiovascular risk factors that differentially affect the predicted rate of coronary artery disease.
肾移植患者的心血管发病率（包括冠状动脉疾病和左心室肥厚）及死亡率较高。心血管疾病被认为是由传统的（高血压、高脂血症、糖尿病和吸烟）以及非传统的心血管危险因素（微炎症）所致。此外，免疫抑制药物，即钙调神经磷酸酶抑制剂、西罗莫司和类固醇，已被报道会对心血管危险因素（如高血压、高脂血症、高血糖）产生不利影响。来自比较试验和转换研究的证据表明，肾移植后的血压、高脂血症和高血糖可能受到钙调神经磷酸酶抑制剂环孢素和他克莫司的不同影响。在欧洲他克莫司与环孢素A微乳剂肾移植研究中，557例患者被随机分配接受他克莫司治疗（n = 286）或环孢素治疗（n = 271）。除了血压、血清胆固醇、高密度脂蛋白胆固醇、甘油三酯和血糖外，我们还估计了冠心病的10年风险（弗雷明汉风险评分）。与环孢素相比，他克莫司导致血清胆固醇的时间加权平均值显著降低（P <.001），平均动脉血压显著降低（P <.05），但血糖的时间加权平均值较高（P <.01）。接受他克莫司治疗的男性的平均10年冠心病风险估计值显著较低（10.0%对13.2%；P <.01），但女性患者中该值无变化（4.7%对7.0%）。他克莫司和环孢素微乳剂对心血管危险因素具有化合物特异性作用，这些作用对预测的冠状动脉疾病发生率有不同影响。
