Eich D, Thompson J A, Ko D J, Hastillo A, Lower R, Katz S, Katz M, Hess M L
Medical College of Virginia, Virginia Commonwealth University, Richmond.
J Heart Lung Transplant. 1991 Jan-Feb;10(1 Pt 1):45-9.
Coronary artery disease remains a significant long-term problem for survival after heart transplantation. Hyperlipidemia is a known risk factor for coronary artery disease in the general population, but the role of hyperlipidemia in cardiac allograft recipients has not been elucidated. To study this problem, we retrospectively reviewed 38 heart transplant recipients who survived more than 3 years after surgery and looked at age, development of diabetes, drug protocol, and development of hypercholesterolemia for a possible correlative or predictive value to the development of early coronary artery disease after heart transplantation. Eleven patients were identified as having coronary disease by the third year after transplantation. High-risk cholesterol values (in milligrams per deciliter) at 6 months after heart transplantation were defined as follows: for ages 10 to 20, 190; 20 to 30, 220; 30 to 40, 240; 40+, 260. We found a strong predictive value with high-risk lipid profiles (p less than 0.01) for the development of coronary artery disease by the third year. No significance was found for a low-risk value, the development of diabetes, or hypertension. All patients below the age of 20 years had coronary artery disease by the third year after transplantation. We conclude that a high-risk cholesterol value at 6 months after transplantation is a strong predictor for development of accelerated coronary artery disease and early graft failure. This has major implications for management of hyperlipidemia in the cardiac allograft recipient.
冠状动脉疾病仍然是心脏移植术后生存面临的一个重大长期问题。高脂血症是一般人群中已知的冠状动脉疾病危险因素，但高脂血症在心脏移植受者中的作用尚未阐明。为研究这一问题，我们回顾性分析了38例术后存活超过3年的心脏移植受者，观察其年龄、糖尿病的发生、药物治疗方案以及高胆固醇血症的发生情况，以探讨其与心脏移植术后早期冠状动脉疾病发生之间可能存在的相关性或预测价值。11例患者在移植后第三年被确诊患有冠状动脉疾病。心脏移植术后6个月时的高危胆固醇值（毫克/分升）定义如下：10至20岁为190；20至30岁为220；30至40岁为240；40岁以上为260。我们发现高危血脂水平对第三年冠状动脉疾病的发生具有很强的预测价值（p小于0.01）。低危值、糖尿病或高血压的发生无显著意义。所有20岁以下的患者在移植后第三年均患有冠状动脉疾病。我们得出结论，移植后6个月时的高危胆固醇值是加速冠状动脉疾病发生和早期移植物功能衰竭的有力预测指标。这对心脏移植受者高脂血症的管理具有重要意义。
