Carrier M, Pelletier G, Leclerc Y, Castonguay Y, Cartier R, Dyrda I, Gosselin G, Pelletier L C
Department of Surgery, Montreal Heart Institute, PQ.
Can J Surg. 1991 Apr;34(2):133-6.
Accelerated coronary atherosclerosis (ACA) has been documented at autopsy and was noted at coronary angiography in seven patients, 11 to 48 months after cardiac transplantation. To delineate the importance of this problem, the risk factors and the therapeutic approaches in 7 patients who had ACA after heart transplantation were compared with those in 28 patients free of ACA at annual coronary angiography. Ischemic cardiomyopathy was the preoperative diagnosis in all but one patient in the ACA group. The age of the transplant recipients, total myocardial ischemic times and arterial blood pressures at follow-up were similar in both groups. Donor age averaged 31 +/- 3 years in the ACA group and 22 +/- 1 years in patients free of ACA. Preoperative cholesterol, triglyceride and high-density lipoprotein levels were lower in ACA-free patients and the low-density lipoprotein level was higher. At the last follow-up visit, serum lipid levels were similar in both groups. The incidence of acute rejection and of infection was slightly, but not significantly, higher in patients with ACA. The actuarial survival of ACA patients 4 years after transplantation was 30% +/- 20% compared with 100% for patients free of ACA (p less than 0.01). Actuarial rates of freedom from ACA and from death due to ACA were 73% +/- 11% and 81% +/- 11% respectively. Stepwise discriminant analysis showed that older donors and higher pretransplant triglyceride levels were independently related to the development of ACA after cardiac transplantation. In conclusion ACA remains an important cause of late death after heart transplantation. Although therapeutic measures are limited, prevention should focus on strict control of serum lipid levels after transplantation.
尸检已证实存在加速性冠状动脉粥样硬化（ACA），并且在心脏移植后11至48个月的冠状动脉造影检查中，7例患者被发现有此情况。为了明确这一问题的重要性，将7例心脏移植后发生ACA的患者的危险因素和治疗方法，与28例每年冠状动脉造影检查未发现ACA的患者进行了比较。ACA组除1例患者外，术前诊断均为缺血性心肌病。两组移植受者的年龄、心肌总缺血时间以及随访时的动脉血压相似。ACA组供者平均年龄为31±3岁，未发生ACA的患者供者平均年龄为22±1岁。术前无ACA患者的胆固醇、甘油三酯和高密度脂蛋白水平较低，而低密度脂蛋白水平较高。在最后一次随访时，两组的血脂水平相似。ACA患者的急性排斥反应和感染发生率略高，但无显著差异。移植后4年，ACA患者的实际生存率为30%±20%，而未发生ACA的患者为100%（p<0.01）。无ACA以及无因ACA导致死亡的实际发生率分别为73%±11%和81%±11%。逐步判别分析显示，供者年龄较大和移植前甘油三酯水平较高与心脏移植后ACA的发生独立相关。总之，ACA仍然是心脏移植后晚期死亡的重要原因。尽管治疗措施有限，但预防应侧重于移植后严格控制血脂水平。
