Naeser Vibeke, Brandt Andreas Hjelm, Nyhuus Bo, Borgwardt Lise, Jørgensen Marianne Hørby, Rasmussen Allan
Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark.
Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
Pediatr Transplant. 2018 Dec;22(8):e13298. doi: 10.1111/petr.13298. Epub 2018 Oct 19.
Increased risk of cardiovascular diseases is well described after adult liver transplantation, whereas the risk in the pediatric population still is discussed. The aim of this study was to investigate the prevalence of metabolic syndrome in pediatric liver transplant recipients and whether measurements of carotid intima media thickness and pulse wave velocity were increased compared to healthy controls.
We included 42 pediatric liver transplantation recipients and examined them for markers of metabolic syndrome, liver fibrosis measured by shear wave velocity, body fat measured by DXA scans and carotid intima-media thickness, and pulse wave velocity (n = 41 for the carotid scans). The ultrasound measurements of carotid intima-media thickness and pulse wave velocity were also conducted on 82 healthy children and adolescents matched on height and age, respectively.
Participants had a median age of 13.03 years, and median time since transplantation was 8.54 years. Compared to healthy controls, liver-transplanted patients had significantly increased intima-media thickness measurements in both control groups whereas there was no significant difference with regard to pulse wave velocity. Two patients (6.25%) were diagnosed with metabolic syndrome. Within the group of liver-transplanted pediatric patients, only elevated body mass index was associated with elevated carotid intima-media thickness measurement. Elevated pulse wave velocity was only associated with abdominal obesity. Factors not significantly correlated with either were age, sex, metabolic syndrome, hyperglycemia, triglycerides, years since transplantation, fibrosis of the liver, body fat content, smoking habits, HDL cholesterol levels, hypertension, and mono-drug versus multi-drug therapies.
Pediatric liver transplant recipients do have an increased risk of increased carotid intima-media thickness.
成人肝移植后心血管疾病风险增加已得到充分描述，而儿童人群中的风险仍在讨论中。本研究的目的是调查儿童肝移植受者代谢综合征的患病率，以及与健康对照相比，颈动脉内膜中层厚度和脉搏波速度的测量值是否增加。
我们纳入了42名儿童肝移植受者，对他们进行代谢综合征标志物、通过剪切波速度测量的肝纤维化、通过双能X线吸收法扫描测量的体脂、颈动脉内膜中层厚度和脉搏波速度的检查（颈动脉扫描n = 41）。还对82名分别在身高和年龄上匹配的健康儿童和青少年进行了颈动脉内膜中层厚度和脉搏波速度的超声测量。
参与者的中位年龄为13.03岁，移植后的中位时间为8.54年。与健康对照相比，肝移植患者在两个对照组中的内膜中层厚度测量值均显著增加，而脉搏波速度方面无显著差异。两名患者（6.25%）被诊断为代谢综合征。在儿童肝移植患者组中，只有体重指数升高与颈动脉内膜中层厚度测量值升高相关。脉搏波速度升高仅与腹部肥胖相关。与之无显著相关性的因素包括年龄、性别、代谢综合征、高血糖、甘油三酯、移植后的年数、肝脏纤维化、体脂含量、吸烟习惯、高密度脂蛋白胆固醇水平、高血压以及单药治疗与多药治疗。
儿童肝移植受者颈动脉内膜中层厚度增加的风险确实更高。
