肾胰联合移植。胰腺门静脉引流与体静脉引流对脂蛋白组成的影响。

Kidney-pancreas transplantation. The effect of portal versus systemic venous drainage of the pancreas on the lipoprotein composition.

作者信息

Hughes T A, Gaber A O, Amiri H S, Wang X, Elmer D S, Winsett R P, Hathaway D K, Hughes S M

机构信息

Department of Medicine, University of Tennessee, Memphis, USA.

出版信息

Transplantation. 1995 Dec 27;60(12):1406-12.

PMID:8545865

Abstract

We have previously shown that both kidney-alone and combined kidney-pancreas transplantation lower VLDL and IDL apoB while increasing LDL apoB, apoA-I, and HDL free cholesterol (FC). In this report, we analyze the lipoproteins of 31 patients who have undergone combined kidney-pancreas transplantation. Systemic venous drainage of the pancreas was utilized in 20 of these patients while 11 had portal venous drainage. Six lipoprotein subfractions (VLDL, IDL, LDL, HDL-L, HDL-M, HDL-D) were isolated by rapid gradient ultracentrifugation using a fixed-angle rotor. The apolipoprotein (by reverse-phase HPLC) and lipid (by enzymatic assays) composition of each subfraction was determined. After three months, there were few group differences. However, the portal group had substantial reductions in VLDL apoB at both six (-50% vs. +1%) and twelve months (-57% vs. +149%, P = .042) while the systemic group had increases in VLDL apoB. Similar differences were seen in IDL apoB (six months: -38% vs. +13%; twelve months: -61% vs. +56%, P = .008). LDL apoB increased in both groups at six months (portal: +7%; systemic: +30%) but fell in the portal group at twelve months (-17% vs. +41%, P = .0007). IDL triglyceride, cholesterol ester, phospholipids, and free cholesterol also fell by 19% to 47% in the portal group while they rose by 8% to 44% in the systemic patients, six and twelve months after surgery (P < .05). In addition, the VLDL and LDL free cholesterol to phospholipid ratios (FC/PL) fell (improved) by 16% to 26% in the portal patients while they rose by 9% to 28% in the systemic subjects during this time (P < .04). Finally, there were substantial improvements in the LDL composition of the portal patients compared to the systemic patients at six (PL/apoB: +23% vs. -16%, P = .005; CE/apoB: +14% vs. -14%, P = .037) and twelve months (PL/apoB: +39% vs. -13%, P = .011; CE/apoB: +41% vs. -15%, P = .011). These data indicate that portal drainage of the transplanted pancreas reduced the number of VLDL, IDL, and LDL particles, reduced the total mass of IDL (by 35%), and normalized the VLDL and LDL particle composition. These improvements were not seen in the patients who received systemic drainage of their pancreas. HDL-M also improved in the portal patients (TG: -29% vs. +12%, P = .025) (PL: +22% vs. -5%, P = .014) (total mass: +16% vs. +0.2%, P = .044) but not in the systemic patients six months after surgery. These results suggest that portal venous drainage of the pancreas leads to greater improvements in the lipoprotein composition of IDDM patients than does systemic drainage.

摘要

我们之前已经表明，单纯肾移植和肾 - 胰联合移植均可降低极低密度脂蛋白（VLDL）和中间密度脂蛋白（IDL）载脂蛋白B，同时增加低密度脂蛋白（LDL）载脂蛋白B、载脂蛋白A - I和高密度脂蛋白（HDL）游离胆固醇（FC）。在本报告中，我们分析了31例接受肾 - 胰联合移植患者的脂蛋白情况。其中20例患者采用胰腺体静脉引流，11例采用门静脉引流。使用固定角度转头通过快速梯度超速离心法分离出六种脂蛋白亚组分（VLDL、IDL、LDL、HDL - L、HDL - M、HDL - D）。测定每个亚组分的载脂蛋白（通过反相高效液相色谱法）和脂质（通过酶法测定）组成。三个月后，两组间差异不大。然而，门静脉组在术后6个月（-50% vs. +1%）和12个月时（-57% vs. +149%，P = 0.042）VLDL载脂蛋白B大幅降低，而体静脉组VLDL载脂蛋白B升高。IDL载脂蛋白B也有类似差异（6个月时：-38% vs. +13%；12个月时：-61% vs. +56%，P = 0.008）。两组患者在6个月时LDL载脂蛋白B均升高（门静脉组：+7%；体静脉组：+30%），但门静脉组在12个月时下降（-17% vs. +41%，P = 0.0007）。术后6个月和12个月时，门静脉组IDL甘油三酯、胆固醇酯、磷脂和游离胆固醇也下降了19%至47%，而体静脉组患者则升高了8%至44%（P < 0.05）。此外，在此期间门静脉组患者的VLDL和LDL游离胆固醇与磷脂的比率（FC/PL）下降（改善）了16%至26%，而体静脉组患者则升高了9%至28%（P < 0.04）。最后，与体静脉组患者相比，门静脉组患者在6个月时（磷脂/载脂蛋白B：+23% vs. -16%，P = 0.005；胆固醇酯/载脂蛋白B：+14% vs. -14%，P = 0.037）和12个月时（磷脂/载脂蛋白B：+39% vs. -13%，P = 0.011；胆固醇酯/载脂蛋白B：+41% vs. -15%，P = 0.011）LDL组成有显著改善。这些数据表明，移植胰腺的门静脉引流减少了VLDL、IDL和LDL颗粒数量，降低了IDL的总质量（降低35%），并使VLDL和LDL颗粒组成正常化。接受胰腺体静脉引流的患者未出现这些改善情况。门静脉组患者的HDL - M也有所改善（甘油三酯：-29% vs. +12%，P = 0.025）（磷脂：+22% vs. -5%，P = 0.014）（总质量：+16% vs. +0.2%，P = 0.044），但体静脉组患者术后6个月未出现这种情况。这些结果表明，与体静脉引流相比，胰腺门静脉引流能使1型糖尿病患者的脂蛋白组成得到更大改善。