长期随访的肾移植受者的冠状动脉钙化

Coronary artery calcification in kidney transplant recipients with long-term follow-up.

作者信息

Shu K-H, Tsai I-C, Ho H-C, Wu M-J, Chen C-H, Cheng C-H, Yu T-M, Chuang Y-W, Huang S-T

机构信息

Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

出版信息

Transplant Proc. 2012 Apr;44(3):687-90. doi: 10.1016/j.transproceed.2011.11.031.

DOI:10.1016/j.transproceed.2011.11.031

PMID:22483469

Abstract

OBJECTIVES

Kidney transplantation (KT) is associated with increased incidence of hypertension, hyperlipidemia, metabolic syndrome, and posttransplant diabetes mellitus that promote the development of coronary artery calcification (CAC). The aim of the current study was to elucidate the extent of CAC and its risk factors among KT patients.

METHODS

A cross-sectional study was performed to evaluate the severity of CAC in our KT patients. Multidetector computed tomography was performed to assess the coronary artery calcium score (CACS). Patients were further stratified according to the CACS as: group 1: 0-10, group 2: 11-100, group 3: 101-300, group 4: 301-1000, and group 5: >1000. Clinical as well as demographic data were compared among groups. Linear regression analysis was performed to determine factors that were associated with CAC.

RESULTS

A total of 99 patients were enrolled in the study. The mean age was 53.5 ± 11.8 years and duration of follow-up post-KT was 11.2 ± 5.9 years. The distribution of CACS in groups 1 through 5 was: 41.4%, 20.2%, 11.1%, 15.2%, and 12.1%, respectively. A significantly higher CACS was found in males, patients with pretransplant diabetes mellitus, older current age, older age at KT, hypertension, higher body weight, higher fasting plasma sugar level and lower high-density lipoprotein (HDL) cholesterol. Twenty-nine (29.3%) patients fulfilled criteria for metabolic syndrome (MS). The CACS was significantly higher in patients with MS than in those without MS. An incremental CACS was found to be correlated with increasing number of MS components (P = .003). Multivariate linear regression revealed that female gender, current age, hypertension, and HDL cholesterol were associated with CAC.

CONCLUSION

KT was associated with high CACS in a significant proportion of patients with long-term follow-up. Several risk factors were identified. Some of them were potentially treatable and should be taken into consideration in the management of KT recipients.

摘要

目的

肾移植（KT）与高血压、高脂血症、代谢综合征及移植后糖尿病的发病率增加相关，这些疾病会促进冠状动脉钙化（CAC）的发展。本研究的目的是阐明KT患者中CAC的程度及其危险因素。

方法

进行一项横断面研究，以评估我们的KT患者中CAC的严重程度。采用多排螺旋计算机断层扫描来评估冠状动脉钙化积分（CACS）。患者根据CACS进一步分层为：第1组：0 - 10，第2组：11 - 100，第3组：101 - 300，第4组：301 - 1000，第5组：>1000。对各组的临床和人口统计学数据进行比较。进行线性回归分析以确定与CAC相关的因素。

结果

共有99例患者纳入研究。平均年龄为53.5±11.8岁，KT后的随访时间为11.2±5.9年。第1组至第5组的CACS分布分别为：41.4%、20.2%、11.1%、15.2%和12.1%。在男性、移植前糖尿病患者中发现CACS显著更高，当前年龄较大、KT时年龄较大、高血压、体重较高、空腹血糖水平较高以及高密度脂蛋白（HDL）胆固醇较低。29例（29.3%）患者符合代谢综合征（MS）标准。MS患者的CACS显著高于无MS患者。发现CACS的增加与MS组分数量的增加相关（P = 0.003）。多变量线性回归显示，女性、当前年龄、高血压和HDL胆固醇与CAC相关。