Paoletti Ernesto, Cassottana Paolo, Amidone Marco, Gherzi Maurizio, Rolla Davide, Cannella Giuseppe
Divisione di Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova, Italy.
Am J Kidney Dis. 2007 Jul;50(1):133-42. doi: 10.1053/j.ajkd.2007.04.013.
Interventional studies of left ventricular hypertrophy (LVH) in renal transplant recipients are scarce and to date evaluated only patients immediately after renal transplantation.
Randomized controlled trial that assessed the effectiveness of angiotensin-converting enzyme (ACE) inhibitors in regressing persistent LVH after successful transplantation.
SETTING & PARTICIPANTS: 70 renal transplant recipients (47 men; age, 30 to 68 years) without diabetes previously randomly assigned to either cyclosporine or tacrolimus therapy, with LVH persisting 3 to 6 months after transplantation.
Subjects were randomly assigned to either lisinopril (ACE-inhibitor group; 36 patients) or no therapy (control group; 34 subjects).
Main outcome was change in left ventricular mass index (LVMi) at month 18.
A consistent decrease in both systolic (SBP) and diastolic blood pressure (DBP) was observed in both groups (between-group differences, -1.7 +/- 3.3 mm Hg; 95% confidence interval [CI], -4.8 to 8.2; P = 0.6 for SBP; 0.3 +/- 2.2 mm Hg; 95% CI, -4.8 to 4.1; P = 0.9 for DBP), whereas LVMi regressed more in the ACE-inhibitor group (between-group difference, 10.1 +/- 16.3 g/m(2.7); 95% CI, 4.2 to 16.1; P < 0.01). A significant interaction of ACE inhibitors with cyclosporine in affecting LVMi change was shown by means of post hoc multiple regression analysis (P < 0.01; differences between cyclosporine and tacrolimus group, 13.3 +/- 3.9 g/m(2.7); 95% CI, 5.3 to 21.2; P < 0.01 in the ACE-inhibitor group; 3.7 +/- 4.2 g/m(2.7); 95% CI, -4.7 to 12.2; P = 0.4 in the control group).
Single-center study with small sample size. Interaction of ACE inhibitors with cyclosporine treatment emerged from post hoc analysis.
A prolonged course of ACE-inhibitor therapy is effective in regressing the persistent LVH of renal transplant recipients by mechanisms independent of effects on BP. This regression seems to be at least in part the effect of an interaction between ACE inhibitors and cyclosporine.
肾移植受者左心室肥厚（LVH）的干预性研究较少，且迄今为止仅对肾移植术后即刻的患者进行了评估。
一项随机对照试验，评估血管紧张素转换酶（ACE）抑制剂在移植成功后使持续性LVH消退的有效性。
70例肾移植受者（47例男性；年龄30至68岁），既往无糖尿病，先前随机分配接受环孢素或他克莫司治疗，移植后LVH持续3至6个月。
受试者被随机分配至赖诺普利组（ACE抑制剂组；36例患者）或不接受治疗组（对照组；34例受试者）。
主要结局指标是第18个月时左心室质量指数（LVMi）的变化。
两组的收缩压（SBP）和舒张压（DBP）均持续下降（组间差异，-1.7±3.3 mmHg；95%置信区间[CI]，-4.8至8.2；SBP的P = 0.6；0.3±2.2 mmHg；95%CI，-4.8至4.1；DBP的P = 0.9），而ACE抑制剂组的LVMi消退更明显（组间差异，10.1±16.3 g/m(2.7)；95%CI，4.2至16.1；P < 0.01）。事后多元回归分析显示，ACE抑制剂与环孢素在影响LVMi变化方面存在显著交互作用（P < 0.01；环孢素组与他克莫司组之间的差异，13.3±3.9 g/m(2.7)；95%CI，5.3至21.2；ACE抑制剂组的P < 0.01；3.7±4.2 g/m(2.7)；95%CI，-4.7至12.2；对照组的P = 0.4）。
单中心、小样本量研究。ACE抑制剂与环孢素治疗的交互作用来自事后分析。
延长疗程的ACE抑制剂治疗可通过独立于对血压影响的机制有效使肾移植受者的持续性LVH消退。这种消退似乎至少部分是ACE抑制剂与环孢素之间相互作用的结果。
