Osorio J M, Pérez Marfil A, Ferreyra C, Pérez Abud R, Ruiz Fuentes M C, Galindo P, de Gracia M C, Osuna A
Department of Nephrology, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Transplant Proc. 2012 Sep;44(7):2063-6. doi: 10.1016/j.transproceed.2012.07.086.
Left ventricular hypertrophy, considered an independent factor for cardiovascular mortality, is frequent among renal transplant recipients (RTR), in whom we investigated changes in left ventricular mass (LVM) after grafting and associations with possible causal factors, especially glucose metabolism and oxidative stress.
We performed a prospective study of 37 RTR without prior diabetes mellitus who were evaluated at three times after transplantation (medians of 0.6, 16 and 28 months) by means of the LVM index (LVMI, echocardiographic measure of LVM related to body surface area, g/m(2)), oral glucose tolerance test and determinations of malondialdehyde and total glutathione (GSH), as well as glomerular filtration rate (GFR) estimate by the Modification of Diet in Renal Disease formula. We calculated the overall increment (DeltaLVMI) and percent change of LVMI. Patients were diagnosed to be prediabetic (PD) or new-onset diabetes after transplant (NODAT) according to ADA criteria.
The mean LVMI decreased significantly over time among whole group baseline = 108.34 ± 27.71 g/m(2) versus middle: 100.03 ± 27.53 g/m(2) versus final: 90.62 ± 24.06 g/m(2) (P = .000). However, 13.5% of subjects showed an increased LVMI and 59.5%, a decrease less than 20%. Patients with NODAT at the end of the study showed a positive DeltaLVMI, which was negative in nondiabetics (0.24 ± 16.14 versus -19.86 ± 12.61 g/m(2), P = .018). Compared with DeltaLVMI(-) recipients, patients with DeltaLVMI(+) showed a greater proportion of PD and NODAT at baseline (60% and 40% versus 18.8% and 12.5%, P = .017), and significantly higher all-time fasting glycemia, lower estimated GFR, and greater increments of malondialdehyde and GSH over time. Those with a <20% LVMI decrease experienced progressive GFR impairment over time, as opposed to those with an LVMI decrease > 20%, who showed greater and improving GFR over the whole study.
LVMI does not always improve in RTR; the evolution of ventricular mass after renal transplantation is influenced by glucose metabolism disorders, oxidative stress, and graft function.
左心室肥厚被认为是心血管疾病死亡率的一个独立因素，在肾移植受者（RTR）中很常见。我们研究了肾移植受者移植后左心室质量（LVM）的变化及其与可能的因果因素的关系，特别是糖代谢和氧化应激。
我们对37例无糖尿病史的肾移植受者进行了一项前瞻性研究，在移植后三个时间点（中位数分别为0.6、16和28个月）对他们进行评估，评估指标包括左心室质量指数（LVMI，通过超声心动图测量的与体表面积相关的左心室质量，g/m²）、口服葡萄糖耐量试验、丙二醛和总谷胱甘肽（GSH）的测定，以及通过肾病饮食改良公式估算的肾小球滤过率（GFR）。我们计算了左心室质量指数的总体增量（ΔLVMI）和百分比变化。根据美国糖尿病协会（ADA）标准，将患者诊断为移植前糖尿病（PD）或移植后新发糖尿病（NODAT）。
在整个研究组中，平均左心室质量指数随时间显著下降（基线时为108.34±27.71 g/m²，中期为100.03±27.53 g/m²，末期为90.62±24.06 g/m²，P = 0.000）。然而，13.5%的受试者左心室质量指数增加，59.5%的受试者下降幅度小于20%。研究结束时患有NODAT的患者ΔLVMI为正值，而非糖尿病患者为负值（0.24±16.14与-19.86±12.61 g/m²，P = 0.018）。与ΔLVMI（-）的受者相比，ΔLVMI（+）的患者在基线时PD和NODAT的比例更高（分别为60%和40%，而不是18.8%和12.5%，P = 0.017），并且空腹血糖一直显著更高，估算的GFR更低，随着时间的推移丙二醛和GSH的增量更大。左心室质量指数下降<20%的患者随着时间的推移肾小球滤过率逐渐受损，而左心室质量指数下降>20%的患者在整个研究过程中肾小球滤过率更高且有所改善。
肾移植受者的左心室质量指数并不总是改善；肾移植后心室质量的变化受糖代谢紊乱、氧化应激和移植肾功能的影响。
