al'Halawani M H, Larsen J L, Miller S, Frisbie K, Taylor R J, Stratta R J
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3020.
Transplantation. 1994 Dec 15;58(11):1204-9.
Hyperlipidemia is a significant risk factor for atherosclerotic vascular disease. We have shown previously that pancreas transplantation (PTX) improves but does not normalize lipids in most PTX recipients. We studied whether pravastatin was effective in treating 10 patients with elevated low density lipoprotein (LDL)-cholesterol (LDL-C) following PTX. Seven men and 3 women were studied. Six received combined kidney-pancreas transplantations, while 4 received PTX alone. Age at time of PTX was 37.2 +/- 2.2 years (mean +/- SEM), and 4 had established coronary artery disease before PTX. Mean cholesterol (C), LDL-C, triglycerides (TG), and high density lipoprotein (HDL)-cholesterol (HDL-C) were 236 +/- 12, 142 +/- 6, 222 +/- 50, and 49 +/- 4 mg/dl before PTX. The LDL to HDL ratio was 3.0 +/- 0.3. After PTX, excluding the first 45 days, mean C, LDL-C, and HDL-C increased to 278 +/- 10, 178 +/- 7, and 63 +/- 6 mg/dl (all P < or = 0.05), respectively. TG, LDL to HDL ratio, and weight were unchanged. Pravastatin (11.7 +/- 0.8 mg/day, mean +/- SEM) was initiated 250 +/- 53 days after PTX. During therapy, C and LDL-C decreased on average to 231 +/- 10 and 134 +/- 8 mg/dl, respectively (both P < 0.01), while HDL did not change. The decreases in C and LDL-C were unexplained by a decrease in weight, cyclosporine dose or concentration, or increase in serum creatinine. However, prednisone dose decreased over the same interval, so a contribution from this variable cannot be excluded. No evidence of toxicity was identified during therapy. This is one of the first reports demonstrating that pravastatin is a safe and effective treatment for elevated C and LDL-C in patients following PTX. However, pravastatin did not increase HDL or decrease TG, as observed in the nontransplantation setting. Whether pravastatin or any hypolipidemia therapy can prevent cardiovascular events or mortality following PTX remains to be established.
高脂血症是动脉粥样硬化性血管疾病的重要危险因素。我们之前已经表明，胰腺移植（PTX）可改善大多数PTX受者的血脂，但不能使其恢复正常。我们研究了普伐他汀对10例PTX后低密度脂蛋白（LDL）胆固醇（LDL-C）升高患者的治疗效果。研究对象包括7名男性和3名女性。6例接受了肾胰腺联合移植，4例仅接受了PTX。PTX时的年龄为37.2±2.2岁（平均值±标准误），4例在PTX前已患有冠状动脉疾病。PTX前平均胆固醇（C）、LDL-C、甘油三酯（TG）和高密度脂蛋白（HDL）胆固醇（HDL-C）分别为236±12、142±6、222±50和49±4mg/dl。LDL与HDL的比值为3.0±0.3。PTX后，排除前45天，平均C、LDL-C和HDL-C分别升至278±10、178±7和63±6mg/dl（均P≤0.05）。TG、LDL与HDL的比值及体重未发生变化。PTX后250±53天开始使用普伐他汀（11.7±0.8mg/天，平均值±标准误）。治疗期间，C和LDL-C平均分别降至231±10和134±8mg/dl（均P＜0.01），而HDL未改变。体重、环孢素剂量或浓度的降低以及血清肌酐的升高均无法解释C和LDL-C的降低。然而，泼尼松剂量在同一时间段内降低，因此不能排除该变量的影响。治疗期间未发现毒性证据。这是首批表明普伐他汀对PTX后患者升高的C和LDL-C是一种安全有效治疗方法的报告之一。然而，与非移植情况下观察到的情况一样，普伐他汀并未升高HDL或降低TG。普伐他汀或任何降血脂治疗能否预防PTX后的心血管事件或死亡率仍有待确定。
