Silverborn Martin, Jeppsson Anders, Mårtensson Gunnar, Nilsson Folke
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Heart Lung Transplant. 2005 Oct;24(10):1536-43. doi: 10.1016/j.healun.2005.01.004.
Cardiovascular disease (CVD) is a common cause of morbidity and mortality after solid-organ transplantation. Both pre-existing cardiovascular risk factors in recipients and immunosuppressive drug toxicity may contribute to CVD. We sought to describe the prevalence of new-onset hypertension, hypercholesterolemia and diabetes mellitus in lung transplant recipients and to identify predisposing factors.
One hundred twenty-six patients without pre-transplant hypertension, hypercholesterolemia or diabetes were included in a retrospective descriptive study. All patients were initially on cyclosporine-based triple immunosuppression. Cumulative prevalence of new-onset hypertension, hypercholesterolemia and diabetes were calculated. A multivariate Cox regression model was used to identify independent pre-operative predictors.
By 3 years after transplantation, 90% of patients had developed at least 1 cardiovascular risk factor and 40% developed > or = 2 risk factors. The cumulative prevalence of new-onset hypertension at 1, 3, 5 and 7 years was 45%, 65%, 67% and 72%, respectively. The corresponding prevalence for hypercholesterolemia was 16%, 33%, 48% and 58%, and for diabetes 6%, 7%, 7% and 10%, respectively. The independent pre-transplant predictors were: for hypertension, diastolic blood pressure (odds ratio: 2.1 per 10 mm Hg [95% confidence interval: 1.3 to 3.5], p = 0.005); for hypercholesterolemia, serum cholesterol level (OR: 1.8 per mmol/liter [95% CI: 1.3 to 2.5], p < 0.001); and, for diabetes, cystic fibrosis diagnosis (OR: 7.4 [95% CI: 1.6 to 35.6], p = 0.01) and blood glucose level (OR 2.2 per mmol/liter [95% CI 1.1 to 4.5], p = 0.02).
The majority of cyclosporine-treated lung transplant recipients develop new-onset hypertension or hypercholesterolemia early after transplantation. Pre-transplant blood pressure, serum cholesterol levels and blood glucose levels are independent predictors of post-transplant hypertension, hypercholesterolemia and diabetes, respectively.
心血管疾病（CVD）是实体器官移植后发病和死亡的常见原因。受者术前已有的心血管危险因素和免疫抑制药物毒性都可能导致CVD。我们试图描述肺移植受者新发高血压、高胆固醇血症和糖尿病的患病率，并确定易感因素。
126例术前无高血压、高胆固醇血症或糖尿病的患者纳入一项回顾性描述性研究。所有患者最初均接受以环孢素为基础的三联免疫抑制治疗。计算新发高血压、高胆固醇血症和糖尿病的累积患病率。采用多因素Cox回归模型确定独立的术前预测因素。
移植后3年时，90%的患者至少出现1种心血管危险因素，40%的患者出现≥2种危险因素。新发高血压在1年、3年、5年和7年时的累积患病率分别为45%、65%、67%和72%。高胆固醇血症的相应患病率分别为16%、33%、48%和58%，糖尿病的相应患病率分别为6%、7%、7%和10%。独立的术前预测因素为：高血压方面，舒张压（比值比：每10 mmHg为2.1 [95%置信区间：1.3至3.5]，p = 0.005）；高胆固醇血症方面，血清胆固醇水平（比值比：每mmol/L为1.8 [95%置信区间：1.3至2.5]，p < 0.001）；糖尿病方面，囊性纤维化诊断（比值比：7.4 [95%置信区间：1.6至35.6]，p = 0.01）和血糖水平（比值比：每mmol/L为2.2 [95%置信区间：1.1至4.5]，p = 0.02）。
大多数接受环孢素治疗的肺移植受者在移植后早期会出现新发高血压或高胆固醇血症。术前血压、血清胆固醇水平和血糖水平分别是移植后高血压、高胆固醇血症和糖尿病的独立预测因素。
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