Zakliczynski M, Boguslawska J, Wojniak E, Zakliczynska H, Ciesla D, Nozynski J, Szygula-Jurkiewicz B, Zeglen S, Zembala M
Silesian Center for Heart Diseases, Zabrze, Poland.
Transplant Proc. 2011 Oct;43(8):3071-3. doi: 10.1016/j.transproceed.2011.08.052.
Statins are used in orthotopic heart transplant (OHT) recipients to avoid acute rejection episodes (ARE) during the first year after surgery and coronary vasculopathy (CAV) thereafter as established in prospective randomized trials, yielding the grounds for the universal use of this group of drugs. The aim of the study was to describe the occurrence of dyslipidemias among OHT recipients after introduction of guidelines suggesting the use of statins in all individuals able to tolerate this therapy.
Medical records of all OHT recipients undergoing routine clinical checkups between January and June 2010 were screened for the presence of dyslipidemia: total cholesterol>5 mmol/L; low-density lipoprotein (LDL)-cholesterol>3 mmol/L; triglycerides>1.65 mmol/L; high-density lipoprotein (HDL)<1 mmol/L in the serum. The study group consisted of 322 subjects including 265 males and 57 females of overall mean age of 53.6±12 and 7±4 years after OHT. There was coronary artery disease (CAD) before OHT in 113 (35%). The average number of ARE was 1.9±1.9 and CAV was diagnosed in 77 (24%) patients. There were 247 (77%) patients on statins. We analyzed clinical, ultrasound, and biochemical evaluations to characterize subjects with dyslipidemias.
At least one dyslipidemia was observed among 212 (66%) including hypercholesterolemia in 121 (38%), high LDL in 135 (42%), hypertriglyceridemia in 110 (34%), and low HDL in 48 (15%) patients. The subjects with dyslipidemia were prone to be older, to have CAD before OHT, and to be hypertensive, overweight, and obese, as well as display an higher HbA1C when diabetic. They were treated less frequently with tacrolimus but showed higher drug levels, and more often were prescribed everolimus.
Despite almost universal use of statins, dyslipidemias were present in 2/3 of OHT recipients. It was related to typical atherosclerotic risk factors; however, the influence of immunosuppressants seemed to also be significant.
他汀类药物用于原位心脏移植（OHT）受者，以避免术后第一年发生急性排斥反应（ARE），并预防此后的冠状动脉血管病变（CAV），这已在前瞻性随机试验中得到证实，为这组药物的广泛使用提供了依据。本研究的目的是描述在引入指南建议所有能够耐受该治疗的个体使用他汀类药物后，OHT受者中血脂异常的发生情况。
对2010年1月至6月期间接受常规临床检查的所有OHT受者的病历进行筛查，以确定是否存在血脂异常：血清总胆固醇>5 mmol/L；低密度脂蛋白（LDL）胆固醇>3 mmol/L；甘油三酯>1.65 mmol/L；高密度脂蛋白（HDL）<1 mmol/L。研究组由322名受试者组成，包括265名男性和57名女性，OHT术后平均年龄分别为53.6±12岁和57±4岁。113名（35%）受试者在OHT术前患有冠状动脉疾病（CAD）。ARE的平均次数为1.9±1.9，77名（24%）患者被诊断为CAV。247名（77%）患者服用他汀类药物。我们分析了临床、超声和生化评估结果，以描述血脂异常患者的特征。
212名（66%）患者中观察到至少一种血脂异常，其中121名（38%）为高胆固醇血症，135名（42%）为高LDL，110名（34%）为高甘油三酯血症，48名（15%）为低HDL。血脂异常患者往往年龄较大，OHT术前患有CAD，患有高血压、超重和肥胖，糖尿病患者的糖化血红蛋白（HbA1C）水平也较高。他们接受他克莫司治疗的频率较低，但药物水平较高，且更常使用依维莫司。
尽管他汀类药物几乎被普遍使用，但2/3的OHT受者存在血脂异常。这与典型的动脉粥样硬化危险因素有关；然而，免疫抑制剂的影响似乎也很显著。
