Cheung A K, DeVault G A, Gregory M C
Medical Service, Veterans Affairs Medical Center, Salt Lake City, UT 84148.
J Am Soc Nephrol. 1993 Jun;3(12):1884-91. doi: 10.1681/ASN.V3121884.
Hypercholesterolemia occurs commonly in renal transplant recipients and may contribute to the high cardiovascular morbidity and mortality in these patients. Although an effective hypolipidemic agent, lovastatin has been associated with rhabdomyolysis and acute renal failure in patients on cyclosporin A (CsA). In this study, lovastatin was administered at 10 mg/day for 8 wk followed by 20 mg/day for 12 wk to six renal transplant recipients who were receiving CsA concomitantly. The 10-mg/day dose was effective, but an additional lipid-lowering effect was seen with the 20-mg/day dose. Both serum total cholesterol and low-density lipoprotein cholesterol levels decreased by 27% at the end of the 20 wk of lovastatin administration. Serum high-density lipoprotein cholesterol and triglyceride levels remained unchanged. No significant clinical or laboratory adverse effects were observed, including muscular symptoms, ophthalmologic abnormalities, or alterations in serum creatine kinase, urea nitrogen, creatinine, transaminases, and CsA levels. Peak and trough plasma concentrations of active lovastatin were comparable to those reported in normal subjects receiving a higher lovastatin dose without CsA. It was concluded that the administration of low-dose (10 to 20 mg/day) lovastatin to renal transplant recipients receiving concomitant CsA can be safe and effective in lowering serum cholesterol.
高胆固醇血症在肾移植受者中很常见，可能是这些患者心血管疾病高发病率和高死亡率的一个原因。洛伐他汀虽是一种有效的降血脂药物，但在接受环孢素A（CsA）治疗的患者中，它与横纹肌溶解症和急性肾衰竭有关。在本研究中，对6名同时接受CsA治疗的肾移植受者给予洛伐他汀，剂量为10mg/天，持续8周，随后为20mg/天，持续12周。10mg/天的剂量是有效的，但20mg/天的剂量有额外的降脂作用。在给予洛伐他汀20周结束时，血清总胆固醇和低密度脂蛋白胆固醇水平均下降了27%。血清高密度脂蛋白胆固醇和甘油三酯水平保持不变。未观察到明显的临床或实验室不良反应，包括肌肉症状、眼科异常或血清肌酸激酶、尿素氮、肌酐、转氨酶和CsA水平的改变。活性洛伐他汀的血浆峰浓度和谷浓度与未服用CsA但服用较高剂量洛伐他汀的正常受试者报告的浓度相当。得出的结论是，对同时接受CsA治疗的肾移植受者给予低剂量（10至20mg/天）洛伐他汀在降低血清胆固醇方面可能是安全有效的。
