Becker D M, Chamberlain B, Swank R, Hegewald M G, Girardet R, Baughman K L, Kwiterovich P O, Pearson T A, Ettinger W H, Renlund D
Department of Biostatistics, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Am J Med. 1988 Nov;85(5):632-8. doi: 10.1016/s0002-9343(88)80234-1.
Accelerated coronary atherosclerosis is a major cause of heart graft failure two years and more after heart transplantation, yet its etiology remains undetermined. We conducted this study to determine the prevalence of coronary risk-associated lipid abnormalities, and the relationship between lipid levels and exposure to corticosteroids and cyclosporine, in heart transplant recipients.
The records of 92 consecutive heart transplant recipients from three different transplantation centers were reviewed. Patients from the three centers varied in age, in corticosteroid regimens, and in the proportion undergoing transplantation for ischemic cardiomyopathy. Although 11 patients were not receiving corticosteroids at the time of the study, all patients had received them immediately after transplantation. In addition to information pertaining to demographics, pretransplant medical history, rejection episodes, drug doses, renal function, and blood glucose levels, data on dietary intake and body weight were collected and plasma lipid levels were measured at the time of record review.
A significant number, 48 (52 percent), of heart transplant recipients were above the sex- and age-adjusted 75th percentile, and 35 (38 percent) were above the 90th percentile for total cholesterol in comparison with a general reference population. Similar elevations were found in low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol levels. Bivariate analysis demonstrated cumulative prednisone exposure (r = 0.40, p = 0.0001) and cumulative cyclosporine exposure (r = 0.22, p = 0.04) but not diet or etiology of pretransplant heart disease to be significantly associated with age- or sex-adjusted total cholesterol percentiles. Low-density lipoprotein cholesterol percentiles were also correlated with cumulative prednisone (r = 0.37, p = 0.001) and cumulative cyclosporine exposure (r = 0.24, p = 0.02). Stepwise multiple linear regression analysis, however, demonstrated cumulative prednisone exposure to be the strongest predictor of both total and low-density lipoprotein cholesterol levels and percentiles (p = 0.0001), independent of cumulative cyclosporine exposure and other clinical variables.
These data suggest that long-term corticosteroid exposure may result in an increased prevalence of unfavorable lipid profiles in heart transplant recipients.
加速性冠状动脉粥样硬化是心脏移植术后两年及更长时间心脏移植物衰竭的主要原因，但其病因仍未明确。我们开展这项研究以确定心脏移植受者中与冠状动脉风险相关的脂质异常的患病率，以及脂质水平与皮质类固醇和环孢素暴露之间的关系。
回顾了来自三个不同移植中心的92例连续心脏移植受者的记录。三个中心的患者在年龄、皮质类固醇治疗方案以及因缺血性心肌病接受移植的比例方面存在差异。尽管11例患者在研究时未接受皮质类固醇治疗，但所有患者在移植后均立即接受了此类治疗。除了有关人口统计学、移植前病史、排斥反应发作、药物剂量、肾功能和血糖水平的信息外，还收集了饮食摄入和体重数据，并在记录审查时测量了血脂水平。
与一般参考人群相比，相当数量（48例，52%）的心脏移植受者的总胆固醇水平高于按性别和年龄调整后的第75百分位数，35例（38%）高于第90百分位数。在低密度脂蛋白胆固醇、甘油三酯和高密度脂蛋白胆固醇水平上也发现了类似的升高。双变量分析表明，累积泼尼松暴露（r = 0.40，p = 0.0001）和累积环孢素暴露（r = 0.22，p = 0.04）与按年龄或性别调整后的总胆固醇百分位数显著相关，但饮食或移植前心脏病病因与之无关。低密度脂蛋白胆固醇百分位数也与累积泼尼松（r = 0.37，p = 0.001）和累积环孢素暴露（r = 0.24，p = 0.02）相关。然而，逐步多元线性回归分析表明，累积泼尼松暴露是总胆固醇和低密度脂蛋白胆固醇水平及百分位数的最强预测因子（p = 0.0001），独立于累积环孢素暴露和其他临床变量。
这些数据表明，长期暴露于皮质类固醇可能导致心脏移植受者中不良脂质谱的患病率增加。
