[同型半胱氨酸水平升高及选定脂质参数对肾移植患者动脉粥样硬化病变进展的影响（通过内膜中层厚度指数（CCA-IMT）评估）]

[Influence of elevated homocystein level and selected lipid parameters in kidney transplant patients on the progression of atherosclerotic changes assessed by intima-media thickness index (CCA-IMT)].

作者信息

Janda Katarzyna, Aksamit Dariusz, Drozdz Maciej, Krzanowski Marcin, Ignacak Ewa, Kowalczyk-Michałek Martyna, Tabor-Ciepiela Barbara, Sułowicz Władysław

机构信息

Katedra i Klinika Nefrologii, Uniwersytet Jagielloński Collegium Medicum, Kraków.

出版信息

Przegl Lek. 2012;69(9):670-4.

PMID:23401987

Abstract

UNLABELLED

The aim of the study was to evaluate the influence of elevated homocystein (Hcy) level and selected lipid parameters on the progression of atherosclerotic changes in patients after kidney transplantation (KTx).

PATIENTS AND METHODS

The study included 51 pts (17 F, 34 M) aged 15-62 years (median 38.1) after cadaver KTx. The mean observation period equaled 21.2 months (6-24 months); while total observation period was 90 patients/ years. Hcy levels was measured using HPLC, Lp(a) and Apo-B levels using the nephelometric method and total cholesterol with its' HDL and LDL fractions, triglycerides and creatinine based on the Hitachi 917 analyzer. Patients' blood was drawn before renal transplantation and 3, 6, 9, 12, 15, 18, 21 and 24 months after KTx. Common carotid artery intima media thickness (CCA-IMT) was evaluated by ultrasound on 14 days, 12 and 24 months after KTx.

RESULTS

CCA-IMT correlated significantly with Hcy levels after 12 months (R=0.53; p=0.0009) and 24 months (R=0.38; p=0.0356) after KTx. Significant differences were found 12 and 24 months after KTx in CCA-IMT between patients with normal (<15 micromol/l) and increased (>15 micromol/ l) mean Hcy concentrations: p=0.0035 and p= 0.015, respectively. Analyzing changes in CCA-IMT, significant differences were noted when comparing the CCA-IMT increment after 12 and 24 months post KTx in patients with normal (< or =15 micromol/l) and increased (>15 micromol/l) homocystein concentrations: p=0.049 and p=0.0039, respectively. Increment of CCA-IMT 12 months after KTx, significantly correlated with mean total cholesterol level (R=0.35; p=0.0333), whereas 24 months after procedure correlated significantly with 0.0315).

CONCLUSIONS

Hcy level is an independent risk factor for atherosclerosis development in patients after KTx. Elevated Hcy level as well as increased cholesterol and Lp(a) levels enhance the progression of atherosclerotic changes evaluated by CCA-IMT in KTx patients.

摘要

未标注

本研究旨在评估高同型半胱氨酸（Hcy）水平及选定的血脂参数对肾移植（KTx）患者动脉粥样硬化病变进展的影响。

患者与方法

本研究纳入了51例尸体肾移植后的患者（17例女性，34例男性），年龄在15 - 62岁（中位数38.1岁）。平均观察期为21.2个月（6 - 24个月）；总观察期为90患者/年。采用高效液相色谱法测定Hcy水平，用散射比浊法测定Lp(a)和载脂蛋白B水平，基于日立917分析仪测定总胆固醇及其高密度脂蛋白和低密度脂蛋白组分、甘油三酯和肌酐。在肾移植前以及肾移植后3、6、9、12、15、18、21和24个月采集患者血液。在肾移植后14天、12个月和24个月通过超声评估颈总动脉内膜中层厚度（CCA - IMT）。

结果

肾移植后12个月（R = 0.53；p = 0.0009）和24个月（R = 0.38；p = 0.0356）时，CCA - IMT与Hcy水平显著相关。肾移植后12个月和24个月，平均Hcy浓度正常（<15 μmol/l）和升高（>15 μmol/l）的患者在CCA - IMT方面存在显著差异：分别为p = 0.0035和p = 0.０15。分析CCA - IMT的变化，比较肾移植后12个月和24个月时同型半胱氨酸浓度正常（≤15 μmol/l）和升高（>15 μmol/l）的患者的CCA - IMT增量时，发现存在显著差异：分别为p = 0.049和p = 0.0039。肾移植后12个月时CCA - IMT的增量与平均总胆固醇水平显著相关（R = 0.35；p = 0.0333），而术后24个月时与……显著相关（p = 0.0315）。

结论

Hcy水平是肾移植患者动脉粥样硬化发展的独立危险因素。高Hcy水平以及升高的胆固醇和Lp(a)水平会加速通过CCA - IMT评估的肾移植患者动脉粥样硬化病变的进展。（注：原文中“whereas 24 months after procedure correlated significantly with 0.0315)”此处0.0315前似乎缺少相关指标，译文按原文翻译）