Rickenbacher P R, Kemna M S, Pinto F J, Hunt S A, Alderman E L, Schroeder J S, Stinson E B, Popp R L, Chen I, Reaven G, Valantine H A
Division of Cardiovascular Medicine, Stanford University School of Medicine, California 94305, USA.
Transplantation. 1996 Jan 15;61(1):46-53. doi: 10.1097/00007890-199601150-00011.
This study examined the hypothesis that immunologic factors are the major correlates of coronary artery intimal thickening and luminal stenosis. The study population included 116 adult heart transplant recipients with a mean age of 44.7 +/- 12.0 years (89 men and 27 women) undergoing annual coronary angiography and intracoronary ultrasound 3.4 +/- 2.7 (range, 1.0-14.6) years after transplantation. Mean intimal thickness was obtained from several distinct sites along the left anterior descending and/or left circumflex coronary artery by intracoronary ultrasound. Coronary artery stenosis defined by angiography was classified as mild (< 30% luminal stenosis), moderate (> or = 30-70% luminal stenosis), or severe (> 70% luminal stenosis or diffuse pruning of distal vessels). Prevalence of any transplant coronary artery disease (TxCAD) was 85% by intracoronary ultrasound and 15% by angiography. By multiple regression analysis, only average fasting plasma triglyceride level (P < 0.006) and average weight (P < 0.007) were significantly correlated with severity of intimal thickening (R = 0.54, P < 0.0001). Donor age (P < 0.006) and average fasting plasma triglyceride level (P < 0.009) were significantly correlated with stenosis by angiography. Correlation of multiple immunologic and metabolic factors with intimal thickness by univariate analysis suggests a multifactorial etiology for TxCAD. Among the multiple univariate correlates of TxCAD, higher fasting plasma triglyceride levels and body weight are the only independent correlates of TxCAD. The absence of acute rejection as an independent predictor of intimal thickening suggests that mechanisms beyond those mediating typical cellular rejection should be targeted for advancing our understanding of Tx-CAD.
本研究检验了免疫因素是冠状动脉内膜增厚和管腔狭窄主要相关因素这一假说。研究对象包括116例成年心脏移植受者，平均年龄44.7±12.0岁（89例男性和27例女性），在移植后3.4±2.7（范围1.0 - 14.6）年接受年度冠状动脉造影和冠状动脉内超声检查。通过冠状动脉内超声从左前降支和/或左旋支冠状动脉的几个不同部位获取平均内膜厚度。血管造影定义的冠状动脉狭窄分为轻度（管腔狭窄<30%）、中度（管腔狭窄≥30 - 70%）或重度（管腔狭窄>70%或远端血管弥漫性截断）。通过冠状动脉内超声检查，任何移植冠状动脉疾病（TxCAD）的患病率为85%，血管造影检查为15%。通过多元回归分析，仅平均空腹血浆甘油三酯水平（P<0.006）和平均体重（P<0.007）与内膜增厚严重程度显著相关（R = 0.54，P<0.0001）。供体年龄（P<0.006）和平均空腹血浆甘油三酯水平（P<0.009）与血管造影显示的狭窄显著相关。单因素分析中多种免疫和代谢因素与内膜厚度的相关性提示TxCAD的多因素病因。在TxCAD的多个单因素相关因素中，较高的空腹血浆甘油三酯水平和体重是TxCAD仅有的独立相关因素。急性排斥反应不存在作为内膜增厚的独立预测因素，这表明除了介导典型细胞排斥反应的机制之外，还应针对其他机制来增进我们对Tx - CAD的理解。
