Park J W, Merz M, Braun P, Vermeltfoort M
Herzzentrum Duisburg Kaiser-Wilhelm-Krankenhaus, Germany.
J Heart Lung Transplant. 1996 Jun;15(6):572-9.
Transplant coronary artery disease is the major cause of late mortality after heart transplantation. The underlying mechanism probably involves various factors including immunologic and nonimmunologic factors.
The influence of various risk factors concerning both the development and the progression of transplant coronary artery disease was analyzed. Fifty-two heart transplant patients, who survived at least 2 years after transplantation (24 to 60 months), were included.
Of these patients 38.5% had angiographic evidence of transplant coronary artery disease. They had significantly higher values of total cholesterol, low-density lipoprotein cholesterol, and log triglycerides than patients without evidence of the disease (p = 0.037, p = 0.002, and p = 0.015, respectively). In addition, preoperative diagnosis of coronary artery disease was a predictor of the development of transplant coronary artery disease, whereas significant differences were not found corresponding to recipient age, donor age, ischemic time, body mass index, lipoprotein (a) value, high-density lipoprotein cholesterol value, time after transplantation, number of postoperative rejection episodes, or prednisone dosage. A 12-month angiographic follow-up indicated disease progression in 25% of the patients. With respect to the majority of factors analyzed within the study, the differences between patients with and those without progression were comparable to the differences between patients in whom transplant coronary artery disease developed and those in whom it did not. However, patients exhibiting disease progression had a higher prednisone intake dosage (p = 0.006) and had significantly higher lipoprotein (a) values (p = 0.0229) than patients without progression.
This study clearly shows that in heart transplant patients surviving more than 2 years, lipid disorder is one of the main risk factors of both the development and the progression of transplant coronary artery disease.
移植后冠状动脉疾病是心脏移植术后晚期死亡的主要原因。其潜在机制可能涉及多种因素，包括免疫和非免疫因素。
分析了与移植后冠状动脉疾病发生和进展相关的各种危险因素的影响。纳入了52例心脏移植患者，这些患者在移植后至少存活2年（24至60个月）。
这些患者中38.5%有移植后冠状动脉疾病的血管造影证据。他们的总胆固醇、低密度脂蛋白胆固醇和甘油三酯对数水平显著高于无该疾病证据的患者（分别为p = 0.037、p = 0.002和p = 0.015）。此外，术前冠状动脉疾病诊断是移植后冠状动脉疾病发生的一个预测因素，而在受者年龄、供者年龄、缺血时间、体重指数、脂蛋白(a)值、高密度脂蛋白胆固醇值、移植后时间、术后排斥反应发作次数或泼尼松剂量方面未发现显著差异。12个月的血管造影随访显示25%的患者疾病进展。就研究中分析的大多数因素而言，疾病进展患者与无进展患者之间的差异与移植后冠状动脉疾病发生患者与未发生患者之间的差异相当。然而，疾病进展患者的泼尼松摄入量较高（p = 0.006），且脂蛋白(a)值显著高于无进展患者（p = 0.0229）。
本研究清楚地表明，在存活超过2年的心脏移植患者中，脂质紊乱是移植后冠状动脉疾病发生和进展的主要危险因素之一。
