Badiou S, Garrigue V, Dupuy A M, Chong G, Cristol J P, Mourad G
Biochemistry Laboratory, Hôpital Lapeyronie, University of Montpellier Medical School, 371 avenue du doyen Gaston Giraud, 34295 Montpellier 05, France.
Transplant Proc. 2006 Sep;38(7):2314-6. doi: 10.1016/j.transproceed.2006.07.003.
Immunosuppressive therapy is frequently associated with dyslipidemia, which is involved in cardiovascular morbidity and mortality in transplant patients. Beyond classical factors, such as low-density lipoprotein (LDL) cholesterol (LDL-C), qualitative abnormalities of lipoproteins, such as presence of the atherogenic factor, small dense LDL, may be of interest for a cardiovascular risk assessment. This study was designed to explore LDL size in renal transplant recipients in relation to quantitative lipid parameters and apolipoprotein (apo) CIII polymorphism.
Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), LDL-C, apoA1, apoB, apoCIII, and LDL size were measured in 62 patients of mean age 45 +/- 13 years including 71% men at 2 +/- 0.5 years after renal transplantation. Thirty-two patients received cyclosporine (CsA), while 30 received tacrolimus (FK). ApoCIII Sstl genotype was determined by restriction fragment length polymorphism.
The CsA group exhibited higher TC (P = .001), LDL-C (P = .004), non-HDL-C (P = .009), HDL-C (P = .03), apoB (P = .008), and apoCIII (P = .002) levels than the FK group. However, LDL-C (CsA: 3.7 +/- 1.2, FK: 3.0 +/- 0.6 mmol/L) and triglyceride levels (CsA: 1.55 mmol/L, FK: 1.37 mmol/L) were near the normal range in both groups. Allelic frequency of the sparse A2 allele associated with hypertriglyceridemia was 6%, similar to the general population. LDL size, which was comparable in the CsA and FK groups (25.87 +/- 0.89 vs 25.75 +/- 0.62 nm, respectively), inversely correlated with TG/HDL ratio (P = 10(-4)). Prevalence of small dense LDL (defined as <25.5 nm) was 26% in the CsA group and 33% in the FK group.
After LDL-C goal has been achieved, LDL size modulation may be taken into account in order to prevent cardiovascular complications.
免疫抑制治疗常与血脂异常相关，这与移植患者的心血管发病率和死亡率有关。除了经典因素，如低密度脂蛋白（LDL）胆固醇（LDL-C）外，脂蛋白的定性异常，如致动脉粥样硬化因子小而密LDL的存在，可能对心血管风险评估有意义。本研究旨在探讨肾移植受者的LDL大小与定量血脂参数及载脂蛋白（apo）CIII多态性的关系。
对62例平均年龄45±13岁的患者进行了总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、LDL-C、apoA1、apoB、apoCIII和LDL大小的检测，其中男性占71%，检测时间为肾移植后2±0.5年。32例患者接受环孢素（CsA）治疗，30例接受他克莫司（FK）治疗。通过限制性片段长度多态性确定apoCIII Sstl基因型。
CsA组的TC（P = 0.001）、LDL-C（P = 0.004）、非HDL-C（P = 0.009）、HDL-C（P = 0.03）、apoB（P = 0.008）和apoCIII（P = 0.002）水平均高于FK组。然而，两组的LDL-C（CsA组：3.7±1.2，FK组：3.0±0.6 mmol/L）和甘油三酯水平（CsA组：1.55 mmol/L，FK组：1.37 mmol/L）均接近正常范围。与高甘油三酯血症相关的稀少A2等位基因的等位基因频率为6%，与一般人群相似。CsA组和FK组的LDL大小相当（分别为25.87±0.89和25.75±0.62 nm），与TG/HDL比值呈负相关（P = 10⁻⁴）。小而密LDL（定义为<25.5 nm）的患病率在CsA组为26%，在FK组为33%。
在达到LDL-C目标后，为预防心血管并发症，可考虑调节LDL大小。
