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肝移植受者脂联素水平降低与心血管事件的关系。

The Relationship Between Hypoadiponectinemia and Cardiovascular Events in Liver Transplant Recipients.

机构信息

Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA.

Department of Medicine and Center for Liver Disease, Inova Fairfax Hospital, Falls Church, VA.

出版信息

Transplantation. 2019 Nov;103(11):2323-2328. doi: 10.1097/TP.0000000000002714.

Abstract

BACKGROUND

Cardiovascular disease (CVD) is an important cause of morbidity and mortality after liver transplantation (LT). Serum adiponectin levels inversely correlate with CVD-related outcomes, but the relationship between hypoadiponectinemia and CVD after LT is unknown. Thus, the aim of the present study was to prospectively evaluate this relationship in LT recipients (LTR).

METHODS

LTR were prospectively enrolled (N = 130) between January 1, 2012, and January 1, 2014. Baseline adiponectin levels were drawn at enrollment and patients were followed for CVD events. Hypoadiponectinemia was defined as serum adiponectin <10 µg/mL. The primary endpoint was a composite CVD outcome consisting of myocardial infarction, angina, need for coronary revascularization, stroke, or cardiac death.

RESULTS

The mean age was 58 ± 11 years and prevalence of obesity, diabetes, and dyslipidemia was 40%, 35%, and 40%, respectively. A total of 20 CVD events were noted, after median follow up of 45 months. Hypoadiponectinemia was significantly associated with future risk of CVD events (hazard ratio, 3.519; 95% confidence interval, 1.180-10.499, P = 0.024). This association was independent of traditional CVD risk factors including age, gender, obesity, hypertension, diabetes, and choice of immunosuppression.

CONCLUSIONS

Hypoadiponectinemia is a strong independent predictor of future cardiovascular events in LTR, which can be incorporated in clinical practice to assess CVD risk assessment after LT.

摘要

背景

心血管疾病(CVD)是肝移植(LT)后发病率和死亡率的重要原因。血清脂联素水平与 CVD 相关结局呈负相关,但 LT 后低脂联素血症与 CVD 的关系尚不清楚。因此,本研究旨在前瞻性评估 LT 受者(LTR)中的这种关系。

方法

2012 年 1 月 1 日至 2014 年 1 月 1 日期间,前瞻性招募 LTR(N=130)。在入组时抽取脂联素基线水平,随访患者 CVD 事件。脂联素减少定义为血清脂联素<10μg/mL。主要终点是由心肌梗死、心绞痛、需要冠状动脉血运重建、中风或心脏死亡组成的复合 CVD 结局。

结果

平均年龄为 58±11 岁,肥胖、糖尿病和血脂异常的患病率分别为 40%、35%和 40%。中位随访 45 个月后,共发生 20 例 CVD 事件。脂联素减少与未来 CVD 事件风险显著相关(危险比,3.519;95%置信区间,1.180-10.499,P=0.024)。这种关联独立于传统 CVD 危险因素,包括年龄、性别、肥胖、高血压、糖尿病和免疫抑制选择。

结论

低脂联素血症是 LTR 未来心血管事件的一个强有力的独立预测因子,可用于临床实践评估 LT 后的 CVD 风险评估。

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