McDiarmid S V, Gornbein J A, Fortunat M, Saikali D, Vargas J H, Busuttil R W, Ament M E
Department of Pediatrics, UCLA School of Medicine.
Transplantation. 1992 Jan;53(1):109-15. doi: 10.1097/00007890-199201000-00021.
Little is known about serum lipid abnormalities in pediatric liver transplant recipients. We performed a longitudinal cohort review of 102 outpatient pediatric liver recipients surviving greater than 6 months and immunosuppressed with cyclosporine and prednisone (+/- azathioprine). The median age was 6 years, median months posttransplant 25, and male-to-female ratio 1:1.5. The average cholesterol (mean of individual means) was 177 +/- 45 mg/dl and average triglyceride level 158 +/- 71 mg/dl. The mean percent of cholesterol levels greater than 170 mg/dl and triglyceride levels greater than 140 mg/dl was 47% and 50%, respectively. Age, obesity, sex, and family history of risk factors had no significant effect on cholesterol or triglyceride levels. Bivariate regression analysis showed no meaningful association between cholesterol or triglyceride levels and cyclosporine levels, cyclosporine dose, prednisone dose, or diastolic blood pressure. Triglyceride and cholesterol neither increased nor decreased with time posttransplant. The rate of change of triglyceride or cholesterol could not be predicted by the rate of change of cyclosporine levels (or dose), or prednisone dose. We found no evidence that rises or falls in cholesterol or triglyceride levels coincided with rises or falls in either cyclosporine level or prednisone dose. Cholestasis was significantly associated with increased cholesterol and triglyceride levels (P = 0.05). A multivariate analysis was unable to predict cholesterol or triglyceride levels from three predictors: cyclosporine level, prednisone dose, and liver function. The mean dietary intake of fat and cholesterol was above RDA and exercise patterns were suboptimal in school-aged children.
50% of children had a mean cholesterol greater than 75th percentile (170 mg/dl); 20% were above the 95th percentile; 56% had a mean triglyceride level greater than 140 mg/dl. By these criteria the majority of pediatric liver transplant patients have lipid abnormalities that may predispose them to atherosclerosis in later life.
关于小儿肝移植受者血清脂质异常情况，人们了解甚少。我们对102名存活超过6个月、接受环孢素和泼尼松（±硫唑嘌呤）免疫抑制治疗的小儿肝移植门诊受者进行了一项纵向队列研究。中位年龄为6岁，移植后中位月数为25个月，男女比例为1:1.5。平均胆固醇（个体均值的均值）为177±45mg/dl，平均甘油三酯水平为158±71mg/dl。胆固醇水平大于170mg/dl和甘油三酯水平大于140mg/dl的平均百分比分别为47%和50%。年龄、肥胖、性别以及危险因素的家族史对胆固醇或甘油三酯水平均无显著影响。双变量回归分析显示，胆固醇或甘油三酯水平与环孢素水平、环孢素剂量、泼尼松剂量或舒张压之间无有意义的关联。移植后甘油三酯和胆固醇水平既未升高也未降低。甘油三酯或胆固醇的变化率无法通过环孢素水平（或剂量）或泼尼松剂量的变化率来预测。我们没有发现证据表明胆固醇或甘油三酯水平的升高或降低与环孢素水平或泼尼松剂量的升高或降低相一致。胆汁淤积与胆固醇和甘油三酯水平升高显著相关（P = 0.05）。多变量分析无法根据环孢素水平、泼尼松剂量和肝功能这三个预测因素来预测胆固醇或甘油三酯水平。学龄儿童的脂肪和胆固醇平均饮食摄入量高于推荐膳食供给量，运动模式也不理想。
50%的儿童平均胆固醇高于第75百分位数（170mg/dl）；20%高于第95百分位数；56%的儿童平均甘油三酯水平大于140mg/dl。按照这些标准，大多数小儿肝移植患者存在脂质异常，这可能使他们在晚年易患动脉粥样硬化。
