Gelens M A C J, Christiaans M H L, v Hooff J P
Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
Transplant Proc. 2005 May;37(4):1900-1. doi: 10.1016/j.transproceed.2005.04.010.
Cardiovascular disease is the leading cause of death in renal transplant recipients. Arterial wall properties are surrogate markers for arteriosclerosis. Previous investigations have shown that the cardiovascular risk profile is better with tacrolimus compared to cyclosporine. Renal function, blood pressure, and lipid levels improve. The hypothesis is that arterial wall properties will improve after conversion from cyclosporine to tacrolimus. Thirty-four stable renal recipients were converted from cyclosporine microemulsion to tacrolimus without changing concomitant medication. Before and after conversion we performed wall track ultrasounds of the carotid and the brachial arteries; pulse wave velocity (PWV); laboratory investigations; 24-hour ABPM; estimates of renal function; and Framingham risk scores. After conversion the 24-hour ambulatory blood pressure monitoring (ABPM) did not change. Total cholesterol, LDL cholesterol, and triglycerides improved significantly. Renal function (Cockroft) improved. There were no significant changes in arterial wall properties, or in PWV. Framingham comparative risk scores improved only significantly in patients not receiving statins. In conclusion, 3 months after conversion from cyclosporine to tacrolimus total cholesterol, LDL cholesterol, and triglycerides were significantly decreased and renal function significantly improved. Contrary to expectation, ABPM did not change, probably due to prolonged use (>10 years) of cyclosporine. There was also no difference in arterial wall properties.
心血管疾病是肾移植受者的主要死因。动脉壁特性是动脉硬化的替代标志物。先前的研究表明，与环孢素相比，他克莫司的心血管风险状况更好。肾功能、血压和血脂水平有所改善。假设是从环孢素转换为他克莫司后动脉壁特性会得到改善。34名稳定的肾移植受者从环孢素微乳剂转换为他克莫司，同时不改变伴随用药。转换前后，我们对颈动脉和肱动脉进行了壁跟踪超声检查；测量了脉搏波速度（PWV）；进行了实验室检查；进行了24小时动态血压监测（ABPM）；评估了肾功能；并计算了弗雷明汉风险评分。转换后，24小时动态血压监测（ABPM）没有变化。总胆固醇、低密度脂蛋白胆固醇和甘油三酯显著改善。肾功能（Cockroft法）有所改善。动脉壁特性和PWV没有显著变化。仅在未接受他汀类药物治疗的患者中，弗雷明汉比较风险评分有显著改善。总之，从环孢素转换为他克莫司3个月后，总胆固醇、低密度脂蛋白胆固醇和甘油三酯显著降低，肾功能显著改善。与预期相反，ABPM没有变化，可能是由于长期使用（>10年）环孢素所致。动脉壁特性也没有差异。
