Pohanka E, Margreiter R, Sparacino V, Sperschneider H
Division of Nephrology und Dialysis, Internal Medicine III, Medizinische Universität Wien, Vienna, Austria.
Transplant Proc. 2005 May;37(4):1874-6. doi: 10.1016/j.transproceed.2005.03.135.
In an open, prospective, multicenter study, stable renal graft recipients were converted to tacrolimus because of cyclosporine-related side effects. Seventy-five patients were switched primarily because of hyperlipidemia. After the switch to tacrolimus, mean total cholesterol was reduced by 15% at month 6. One hundred seventy-seven additional patients were switched primarily for other indications: hypertrichosis, gingival hyperplasia, and arterial hypertension, and these symptoms also improved after the switch. In this analysis, serum lipid levels were categorized according to a modified standard classification of lipid parameters for renal transplant patients (published by the NKF Work Group). The aim was to estimate the proportion of patients reaching normal lipid levels after the conversion to tacrolimus therapy. In patients with primary indication hyperlipidemia, the proportion with normal cholesterol levels increased significantly from 5.6% at baseline to 37.5% at month 6 (P < .05). For LDL cholesterol, the increase was from 54.1% at baseline to 64.9% at month 6, and for triglycerides the improvement was from 25.4% to 33.8%. HDL cholesterol levels remained stable. Similar changes of lipid parameters were also observed in the subgroups of patients converted to tacrolimus primarily because of other indications. After conversion from cyclosporine to tacrolimus, a significantly higher proportion of stable renal graft recipients reached normal total cholesterol levels. For LDL cholesterol and triglycerides, a trend for normalization was observed. Thus, the improvement of serum lipid levels resulted for many patients in a change to a better level class and improved or normalized their cardiovascular risk parameters.
在一项开放性、前瞻性、多中心研究中，稳定的肾移植受者因环孢素相关副作用而转换为使用他克莫司。75名患者主要因高脂血症而换药。转换为他克莫司后，第6个月时平均总胆固醇降低了15%。另有177名患者主要因其他指征换药：多毛症、牙龈增生和动脉高血压，换药后这些症状也有所改善。在该分析中，血清脂质水平根据肾移植患者脂质参数的改良标准分类（由NKF工作组发布）进行分类。目的是评估转换为他克莫司治疗后达到正常脂质水平的患者比例。在以高脂血症为主要指征的患者中，胆固醇水平正常的患者比例从基线时的5.6%显著增加至第6个月时的37.5%（P < 0.05）。对于低密度脂蛋白胆固醇，这一比例从基线时的54.1%增加至第6个月时的64.9%，对于甘油三酯，改善情况是从25.4%至33.8%。高密度脂蛋白胆固醇水平保持稳定。在主要因其他指征而转换为他克莫司的患者亚组中也观察到了脂质参数的类似变化。从环孢素转换为他克莫司后，显著更高比例的稳定肾移植受者达到了正常的总胆固醇水平。对于低密度脂蛋白胆固醇和甘油三酯，观察到了趋于正常化的趋势。因此，对许多患者而言，血清脂质水平的改善导致其水平类别变为更好，心血管风险参数得到改善或正常化。
