Renlund D G, Bristow M R, Crandall B G, Burton N A, Doty D B, Karwande S V, Gay W A, Jones K W, Hegewald M G, Hagan M E
Division of Cardiology, University of Utah Medical Center, Salt Lake City 84132.
J Heart Transplant. 1989 May-Jun;8(3):214-9; discussion 219-20.
Most heart transplant recipients develop hypercholesterolemia, the cause of which is poorly understood. To test the hypothesis that corticosteroids contribute to the hypercholesterolemia, we reviewed 117 consecutive heart transplant recipients who survived more than 4 months, of whom 51 (44%) required and 66 (56%) did not require maintenance corticosteroids, chronic immunosuppression maintained with cyclosporine and azathioprine only. Fasting serum cholesterol levels were measured every 3 months and were found to be 21% to 26% lower during the first 18 months after heart transplantation in the group that did not require chronic corticosteroid administration (p less than 0.001). Beginning 3 months after transplantation, average serum cholesterol levels ranged from 199 +/- 8 mg/dl to 211 +/- 9 mg/dl in the corticosteroid-free group compared with 262 +/- 8 mg/dl to 272 +/- 8 mg/dl in patients requiring corticosteroid maintenance immunosuppression. Because serum cyclosporine levels did not differ between the groups, a contribution by cyclosporine to posttransplant hypercholesterolemia could not be substantiated. Although the hypercholesterolemia that occurs after heart transplantation is undoubtedly multifactorial, corticosteroid administration contributes importantly to its development.
大多数心脏移植受者会出现高胆固醇血症，但其病因尚不清楚。为了验证皮质类固醇导致高胆固醇血症这一假说，我们回顾了117例存活超过4个月的连续心脏移植受者，其中51例（44%）需要维持皮质类固醇治疗，66例（56%）不需要，慢性免疫抑制仅用环孢素和硫唑嘌呤维持。每3个月测量一次空腹血清胆固醇水平，发现在心脏移植后的前18个月内，不需要长期使用皮质类固醇治疗的组中，该水平降低了21%至26%（p<0.001）。移植后3个月开始，无皮质类固醇组的平均血清胆固醇水平在199±8mg/dl至211±9mg/dl之间，而需要皮质类固醇维持免疫抑制的患者中，该水平在262±8mg/dl至272±8mg/dl之间。由于两组间血清环孢素水平无差异，因此无法证实环孢素对移植后高胆固醇血症有影响。虽然心脏移植后出现的高胆固醇血症无疑是多因素的，但皮质类固醇的使用对其发展有重要作用。
