Becker-Cohen Rachel, Nir Amiram, Rinat Choni, Feinstein Sofia, Algur Nurit, Farber Benjamin, Frishberg Yaacov
Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1284-92. doi: 10.2215/CJN.01480506. Epub 2006 Sep 20.
Despite good outcomes in pediatric renal transplantation, life expectancy is reduced, mostly as a result of accelerated atherosclerosis. A comprehensive evaluation of cardiac status and risk factors for cardiovascular disease was performed in 60 patients after renal transplantation (age 3 to 29 yr; mean 15.8). Posttransplantation diabetes was diagnosed in 7%. Half of the patients did not engage in any physical activity, and this was associated with increased body mass index. Uncontrolled hypertension was found in 13% of patient, and 53% were on antihypertensive medications. BP index was associated with left ventricular mass index (LVMI). Dyslipidemia was relatively uncommon, with hypercholesterolemia found in 15% and elevated LDL cholesterol found in 10% of patients. Hyperhomocysteinemia was frequent (58%); in most patients, it was not due to folate or B(12) deficiency. Lipid and homocysteine abnormalities were associated with cyclosporine therapy. Echocardiography demonstrated normal LVMI in 93% of patients, although LVMI was higher than in healthy control subjects. Cardiac troponin I was normal in all patients, but N-terminal pro-brain natriuretic peptide was elevated in 35% and was associated with LVMI and renal function. Although present cardiac status is relatively normal in pediatric renal transplantation patients, cardiac risk factors are common, and strategies to prevent cardiovascular disease need to be developed.
尽管小儿肾移植取得了良好的效果，但预期寿命仍会缩短，主要是由于动脉粥样硬化加速。对60例肾移植患者（年龄3至29岁；平均15.8岁）进行了心脏状况和心血管疾病危险因素的综合评估。7%的患者被诊断为移植后糖尿病。一半的患者未进行任何体育活动，这与体重指数增加有关。13%的患者存在未控制的高血压，53%的患者正在服用抗高血压药物。血压指数与左心室质量指数（LVMI）相关。血脂异常相对少见，15%的患者存在高胆固醇血症，10%的患者低密度脂蛋白胆固醇升高。高同型半胱氨酸血症很常见（58%）；在大多数患者中，这并非由于叶酸或维生素B12缺乏所致。脂质和同型半胱氨酸异常与环孢素治疗有关。超声心动图显示93%的患者左心室质量指数正常，尽管左心室质量指数高于健康对照者。所有患者的心肌肌钙蛋白I均正常，但35%的患者N末端脑钠肽前体升高，且与左心室质量指数和肾功能相关。尽管小儿肾移植患者目前的心脏状况相对正常，但心脏危险因素很常见，需要制定预防心血管疾病的策略。
