Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
J Clin Lipidol. 2021 Mar-Apr;15(2):301-310. doi: 10.1016/j.jacl.2021.01.009. Epub 2021 Feb 2.
Transplant vasculopathy (TV) is a major contributing factor to chronic graft failure in renal transplant recipients (RTR). TV lesions resemble atherosclerosis in several ways, and it is plausible to believe that some risk factors influence both atherosclerotic plaque formation and formation of TV.
The objective of this prospective longitudinal study was to determine if dyslipidemia reflected by the triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is prospectively associated with death censored chronic graft failure in RTR.
454 prospectively included RTR with a functioning graft for at least one year, were followed for a median of 7 years. RTR were matched based on propensity scores to avoid potential confounding and subsequently the association of the TG/HDL-C ratio with the endpoint chronic graft failure, defined as return to dialysis or re-transplantation, was investigated.
Linear regression analysis showed that concentration of insulin, male gender, BMI and number of antihypertensives predict the TG/HDL-C ratio. Cox regression showed that the TG/HDL-C ratio is associated with chronic graft failure (HR = 1.43, 95%CI = 1.12-1.84, p = 0.005) in competing risk analysis for mortality. Interaction testing indicated that the relationship of the TG/HDL-C ratio with graft failure is stronger in subjects with a higher insulin concentration.
Our results demonstrate that the TG/HDL-C ratio has the potential to act as a predictive clinical biomarker. Furthermore, there is a need for closer attention to lipid management in RTR in clinical practice with a focus on triglyceride metabolism.
移植血管病（TV）是导致肾移植受者（RTR）慢性移植物失功的主要因素。TV 病变在多个方面类似于动脉粥样硬化，因此可以认为某些危险因素既影响动脉粥样硬化斑块的形成，也影响 TV 的形成。
本前瞻性纵向研究的目的是确定反映血脂异常的甘油三酯（TG）/高密度脂蛋白胆固醇（HDL-C）比值是否与 RTR 的死亡相关慢性移植物失功有前瞻性关联。
454 例至少有 1 年功能移植物的前瞻性纳入 RTR，中位随访时间为 7 年。根据倾向评分对 RTR 进行匹配，以避免潜在的混杂因素，然后研究 TG/HDL-C 比值与终点慢性移植物失功（定义为返回透析或再次移植）的关联。
线性回归分析显示，胰岛素浓度、男性、BMI 和降压药的数量预测 TG/HDL-C 比值。Cox 回归显示，在竞争风险分析中，TG/HDL-C 比值与慢性移植物失功相关（HR=1.43，95%CI=1.12-1.84，p=0.005）。交互检验表明，在胰岛素浓度较高的患者中，TG/HDL-C 比值与移植物失功的关系更强。
我们的研究结果表明，TG/HDL-C 比值有可能成为一种预测性临床生物标志物。此外，在临床实践中，需要更加关注 RTR 的血脂管理，重点关注甘油三酯代谢。
