Kasiske B L, Guijarro C, Massy Z A, Wiederkehr M R, Ma J Z
Department of Medicine, University of Minnesota College of Medicine, Minneapolis 55415, USA.
J Am Soc Nephrol. 1996 Jan;7(1):158-65. doi: 10.1681/ASN.V71158.
Although cardiovascular disease is a major cause of morbidity and mortality after renal transplantation, its pathogenesis and treatment are poorly understood. We conducted separate analyses of risk factors for ischemic heart disease, cerebral, and peripheral vascular disease after 706 renal transplants, all of which functioned for at least 6 months. We used Cox proportional hazards analysis to examine the effects of multiple pretransplant and posttransplant risk factors and included time-dependent variables measured at 3, 6, and 12 months, and annually to last follow-up at 7.0 +/- 4.2 yr. The independent relative risk (RR) of diabetes was 3.25 for ischemic heart disease, 3.21 for cerebral vascular disease, and 28.18 peripheral vascular disease (P < 0.05). The RR of each acute rejection episode was 1.40 for ischemic heart disease and 1.24 for cerebral vascular disease. Among serum lipid levels, high-density lipoprotein cholesterol was the best predictor of ischemic heart disease (RR = 0.80 for each 10 mg/dL). Posttransplant ischemic heart disease was strongly predictive of cerebral (5.80) and peripheral vascular disease (5.22), whereas ischemic heart disease was predicted by posttransplant cerebral (8.25) and peripheral vascular disease (4.58). Other risk factors for vascular disease included age, gender, cigarette smoking, pretransplant splenectomy, and serum albumin. Hypertension and low-density lipoprotein cholesterol had no effect, perhaps because of aggressive pharmacologic treatment. Thus, the incidence of cardiovascular disease continues to be high after renal transplantation, and multiple risk factors suggest a number of possible strategies for more effective treatment and prevention.
尽管心血管疾病是肾移植后发病和死亡的主要原因，但其发病机制和治疗方法仍知之甚少。我们对706例肾移植术后的缺血性心脏病、脑血管疾病和外周血管疾病的危险因素进行了单独分析，所有移植肾均至少发挥功能6个月。我们使用Cox比例风险分析来检验多个移植前和移植后危险因素的影响，并纳入了在3、6和12个月以及每年直至7.0±4.2年最后随访时测量的时间依赖性变量。糖尿病的独立相对风险（RR）在缺血性心脏病中为3.25，在脑血管疾病中为3.21，在外周血管疾病中为28.18（P<0.05）。每次急性排斥反应的RR在缺血性心脏病中为1.40，在脑血管疾病中为1.24。在血脂水平中，高密度脂蛋白胆固醇是缺血性心脏病的最佳预测指标（每10mg/dL的RR = 0.80）。移植后缺血性心脏病强烈预测脑血管疾病（5.80）和外周血管疾病（5.22），而缺血性心脏病则由移植后脑血管疾病（8.25）和外周血管疾病（4.58）预测。血管疾病的其他危险因素包括年龄、性别、吸烟、移植前脾切除术和血清白蛋白。高血压和低密度脂蛋白胆固醇没有影响，可能是因为积极的药物治疗。因此，肾移植后心血管疾病的发病率仍然很高，多种危险因素提示了一些更有效的治疗和预防策略。
