Seymen P, Yildiz M, Türkmen M F, Titiz M I, Seymen H O
Department of Nephrology/Internal Medicine, Haydarpasa Numune Educational and Research Hospital, Istanbul, Turkey.
Transplant Proc. 2009 Dec;41(10):4181-3. doi: 10.1016/j.transproceed.2009.09.069.
In renal transplant recipients, cyclosporine treatment appears to cause more frequent hyperlipidemia than tacrolimus usage. In this study, hyperlipidemic renal transplant recipients who use cyclosporine were investigated for changes in high-density lipoprotein (HDL)-2/3, apolipoprotein (Apo) A1/B, other lipid and biochemical parameters, and body mass index after prospective cyclosporine to tacrolimus switching.
Fifteen patients, including 9 females of overall mean age of 33.2 +/- 10.7 years and posttransplantation time of 78.06 +/- 42.93 months with a mean body mass index of 23.77 +/- 3.34 kg/m(2), were included if they were nondiabetic, hyperlipidemic, and had undergone renal transplantation between 1992 and 2000, using cyclosporine and candidates for a switch to tacrolimus due to hyperlipidemia. Before switching to tacrolimus and at 12 months of tacrolimus use we studied fasting blood samples for creatinine, uric acid, glucose, triglyceride, Apo A1, Apo B, low-density lipoprotein (LDL), HDL2, HDL3, and total cholesterol.
There were no significant differences in creatinine, uric acid, glucose levels, or body mass index before tacrolimus versus 12 months thereafter. It was observed that tacrolimus significantly decreased triglyceride, Apo A1, Apo B, LDL, HDL, and total cholesterol levels (P < .001; P = .006; P = .01; P < .001; P = .03; P </= .001, respectively), but had no effect on homocysteine, Apo A1/B, HDL 2, HDL 3, or HDL 2/3 levels (P > .05).
Switching from cyclosporine to tacrolimus was associated with a more favorable cardiovascular risk profile by improving hyperlipidemia.
在肾移植受者中，与使用他克莫司相比，环孢素治疗似乎更常导致高脂血症。在本研究中，对使用环孢素的高脂血症肾移植受者进行前瞻性的环孢素转换为他克莫司治疗后，观察其高密度脂蛋白（HDL）-2/3、载脂蛋白（Apo）A1/B、其他血脂及生化参数以及体重指数的变化。
纳入15例患者，其中9例女性，总体平均年龄为33.2±10.7岁，移植后时间为78.06±42.93个月，平均体重指数为23.77±3.34kg/m²，入选标准为非糖尿病、高脂血症，于1992年至2000年间接受肾移植，使用环孢素且因高脂血症而有转换为他克莫司治疗的指征。在转换为他克莫司治疗前以及使用他克莫司12个月时，采集空腹血样检测肌酐、尿酸、血糖、甘油三酯、Apo A1、Apo B、低密度脂蛋白（LDL）、HDL2、HDL3和总胆固醇。
他克莫司治疗前与治疗12个月后的肌酐、尿酸、血糖水平或体重指数无显著差异。观察到他克莫司显著降低甘油三酯、Apo A1、Apo B、LDL、HDL和总胆固醇水平（P分别＜0.001；P = 0.006；P = 0.01；P＜0.001；P = 0.03；P≤0.001），但对同型半胱氨酸、Apo A1/B、HDL 2、HDL 3或HDL 2/3水平无影响（P＞0.05）。
从环孢素转换为他克莫司可改善高脂血症，从而具有更有利的心血管风险状况。
