Guízar-Mendoza Juan Manuel, Amador-Licona Norma, Lozada Efrén Edgard, Rodriguez Leticia, Gutiérrez-Navarro María, Dubey-Ortega Luis Antonio, Trejo-Bellido José, Encarnación José de Jesús, Ruiz-Jaramillo María De la Cruz
Unidad de Investigación Epidemiológica UMAE 48 del Instituto Mexicano del Seguro Social, Lopez Mateos e Insurgentes s/n Colonia Paraísos, Z.C. 37320, León, Mexico.
Pediatr Nephrol. 2006 Oct;21(10):1413-8. doi: 10.1007/s00467-006-0238-8. Epub 2006 Aug 15.
Recent studies considered that an increase in sympathetic activity (SA) may be responsible for left ventricular hypertrophy (LVH). Before and after renal transplantation (RT), we evaluated changes on left ventricular mass (LVM) and SA in 40 end-stage renal disease patients between 8 and 35 years old. Hypertension (95.0% vs. 71.0%; p=0.005), use of combined antihypertensive drugs (57.5% vs. 30.0%; p=0.01), and LVH (77.5% vs. 52.5%; p=0.01) significantly decreased after RT whereas low-to-high frequency ratio (LF/HF), which represents SA, increased (3.1 vs. 5.3; p=0.0001). However, LVM regressors (with decrease on LVM index more than 20%) showed a trend of lower change on LF/HF ratio (1.6 vs. 2.4; p= 0.09) than nonregressors. Living-donor graft, baseline LVM, use of antihypertensive drugs, lower change on LF/HF ratio, and lower systolic blood pressure levels were associated with LVM regression in the simple correlation analysis. However, in the logistic regression analysis, only baseline LVM and donor type remained in the model (R(2)=0.35; p=0.0003). Thus, LVH decreased after RT and was related to baseline LVM and living-donor type. However, it is possible that the higher persistence of LVH after RT could be explained at least in part by increase in heart sympathetic activity and use of immunosuppressors.
近期研究认为，交感神经活动（SA）增加可能是左心室肥厚（LVH）的原因。在肾移植（RT）前后，我们评估了40名8至35岁终末期肾病患者的左心室质量（LVM）和SA的变化。肾移植后，高血压（95.0%对71.0%；p = 0.005）、联合使用抗高血压药物的情况（57.5%对30.0%；p = 0.01）以及LVH（77.5%对52.5%；p = 0.01）显著降低，而代表SA的低频与高频比值（LF/HF）升高（3.1对5.3；p = 0.0001）。然而，LVM回归者（LVM指数下降超过20%）的LF/HF比值变化趋势（1.6对2.4；p = 0.09）低于非回归者。在简单相关性分析中，活体供体移植、基线LVM、抗高血压药物的使用、LF/HF比值的较低变化以及较低的收缩压水平与LVM回归相关。然而，在逻辑回归分析中，模型中仅保留了基线LVM和供体类型（R² = 0.35；p = 0.0003）。因此，肾移植后LVH降低，且与基线LVM和活体供体类型有关。然而，肾移植后LVH较高的持续性至少部分可能是由心脏交感神经活动增加和免疫抑制剂的使用所解释的。
