Guckelberger O, Bechstein W O, Neuhaus R, Luesebrink R, Lemmens H P, Kratschmer B, Jonas S, Neuhaus P L
Department of Surgery, Virchow Clinic, Humboldt University, Berlin, Germany.
Clin Transplant. 1997 Feb;11(1):60-5.
In a retrospective study the records of 302 adult patients (167 male, 135 female) after orthotopic liver transplantation (OLT) with a minimum follow-up of 6 months (median follow-up 18 months, maximum 5 yr) were reviewed with regard to cardiovascular risk factors. In 197 patients data concerning the occurrence of arterial hypertension, hyperglycemia, or hypercholesterolemia prior to OLT were available. We found a highly significant increase of cardiovascular risk factors following OLT. Obesity was found in 17.4% of male and 22.2% of female recipients after OLT. Hypercholesterolemia was evident in 66.2% of liver graft recipients. Hypertriglyceridemia occurred in 49.7% of all male patients. In females there was a significantly different prevalence of hypertriglyceridemia comparing patients with a follow-up period up to 2 yr and more than 2 yr (50% vs. 24.6%, p = 0.018). Nearly 45% of all patients met the criteria for arterial hypertension, with a slight increase in male patients beyond the second year of survival (p = 0.094). Hyperglycemia had a significantly higher frequency in male than in female patients (30.5% vs. 10.4%, p < 0.005). Furthermore we observed a clear trend towards reduction of occurrence of hyperglycemia more than 24 months after OLT, but not reaching statistical significance. No correlation was detected when serum levels of triglycerides, and cholesterol, body-mass-index, and arterial blood pressure were compared with applied dosages of immunosuppressive agents [cyclosporin A (CyA), tacrolimus, and prednisolone]. Only decreasing tacrolimus application was significantly correlated with decreasing glucosemia (p = 0.041). Patients receiving tacrolimus instead of CyA as primary immunosuppressant showed a significantly lower prevalence of hypercholesterolemia. Even hypertension, hyperglycemia, hypertriglyceridemia, and obesity had a lower occurrence in patients treated with tacrolimus although not reaching statistical significance.
在一项回顾性研究中，我们对302例接受原位肝移植（OLT）的成年患者（167例男性，135例女性）的记录进行了审查，这些患者的最短随访时间为6个月（中位随访时间为18个月，最长为5年），审查内容涉及心血管危险因素。在197例患者中，可获得OLT前动脉高血压、高血糖或高胆固醇血症发生情况的数据。我们发现OLT后心血管危险因素显著增加。OLT后，17.4%的男性受者和22.2%的女性受者存在肥胖。66.2%的肝移植受者有高胆固醇血症。49.7%的男性患者出现高甘油三酯血症。在女性中，随访期达2年及超过2年的患者高甘油三酯血症患病率有显著差异（50%对24.6%，p = 0.018）。近45%的患者符合动脉高血压标准，男性患者在生存第二年之后略有增加（p = 0.094）。高血糖在男性患者中的发生率显著高于女性患者（30.5%对10.4%，p < 0.005）。此外，我们观察到OLT后24个月以上高血糖发生率有明显下降趋势，但未达到统计学显著性。当比较甘油三酯和胆固醇的血清水平、体重指数和动脉血压与免疫抑制剂[环孢素A（CyA）、他克莫司和泼尼松龙]的应用剂量时，未检测到相关性。仅他克莫司应用剂量的减少与血糖降低显著相关（p = 0.041）。接受他克莫司而非CyA作为主要免疫抑制剂的患者高胆固醇血症患病率显著较低。即使是高血压、高血糖、高甘油三酯血症和肥胖，在接受他克莫司治疗的患者中发生率也较低，尽管未达到统计学显著性。
