Department of Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, California 91010, USA.
Endocr Pract. 2012 Jan-Feb;18(1):90-7. doi: 10.4158/Ep11212.RA.
To review the available literature on severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver.
A literature search was conducted in PubMed for articles on hypercholesterolemia occurring in the context of graft-vs-host disease after allogeneic hematopoietic stem cell transplantation. The review included the type of lipid abnormalities observed, complications, and available management strategies.
Severe hypercholesterolemia can occur in patients who develop graft-vs-host disease after transplant. We describe 8 patients with severe hypercholesterolemia occurring in the context of graft-vs-host disease affecting the liver after hematopoietic stem cell transplantation (7 from the literature and 1 from our institution). No association was observed with a specific age, sex, type of hematologic malignancy, or use of a specific immunosuppressant. The elevated cholesterol is either due to high concentrations of lipoprotein X or low-density lipoprotein. Unlike low-density lipoprotein, lipoprotein X may not be atherogenic.
Treatment may not be required when lipoprotein X is the major elevated lipoprotein unless hyperviscosity occurs, but treatment is indicated when there is elevation in low-density lipoprotein. Plasmapheresis may be necessary. Ultimate treatment is control of the graft-vs-host disease affecting the liver that would improve or completely resolve the hyperlipidemia.
回顾肝移植物抗宿主病时发生严重高胆固醇血症的相关文献。
在 PubMed 上检索了异基因造血干细胞移植后移植物抗宿主病时发生高胆固醇血症的相关文章。综述包括观察到的血脂异常类型、并发症和可用的治疗策略。
发生移植物抗宿主病的患者可出现严重高胆固醇血症。我们描述了 8 例造血干细胞移植后肝移植物抗宿主病时发生严重高胆固醇血症的患者（7 例来自文献，1 例来自我们的机构）。未观察到特定年龄、性别、血液恶性肿瘤类型或特定免疫抑制剂使用与该疾病有相关性。升高的胆固醇要么是由于脂蛋白 X 或低密度脂蛋白浓度升高所致。与低密度脂蛋白不同，脂蛋白 X 可能没有致动脉粥样硬化性。
如果主要升高的脂蛋白是脂蛋白 X，则可能不需要治疗，除非发生高黏度血症，但如果低密度脂蛋白升高，则需要治疗。可能需要进行血浆置换。最终的治疗方法是控制肝移植物抗宿主病，这将改善或完全解决高脂血症。
