Brown J H, Murphy B G, Douglas A F, Short C D, Bhatnagar D, Mackness M I, Hunt L P, Doherty C C, Durrington P N
The Renal Unit, University of Manchester, UK.
Nephron. 1997;75(3):277-82. doi: 10.1159/000189549.
Coronary heart disease (CHD) is more common in patients with chronic renal failure and is a major cause of death after renal transplantation. Elevated serum levels of lipoprotein(a) (Lp(a)) are a known risk factor for CHD in the general population and levels have been reported to be increased in renal transplant recipients. It has been suggested that cyclosporin may elevate Lp(a) levels. We therefore measured the serum concentration of Lp(a) in 50 renal transplant recipients who were receiving cyclosporin alone as immunosuppressive therapy and 50 who were treated with azathioprine and prednisolone, but not cyclosporin. The patients attended two renal transplant centres, one where cyclosporin alone was used as immunosuppressive treatment when possible and another where many patients commenced on azathioprine and prednisolone remain on this medication rather than cyclosporin. Patients in each group were matched for age and sex, but the time since transplantation was greater in those not receiving cyclosporin. Transplant function, obesity and the underlying cause of renal disease were similar in both groups of patients. Median Lp(a) concentration in the cyclosporin monotherapy group was 32.0 (range <0.8-140.3) mg/dl and was significantly (p < 0.05) greater than that of the azathioprine and prednisolone group which was 18.3 (range <0.8-167.7) mg/dl. The serum high-density lipoprotein (HDL) cholesterol concentration, which was 1.24 +/- 0.39 mmol/l (mean +/- SD) in patients receiving cyclosporin, was significantly (p < 0.05) less than that of those treated with azathioprine and prednisolone in whom it was 1.41 +/- 0.40 mmol/l. The lower level in those on cyclosporin was due to a decrease in the HDL2 subfraction. Serum lipid and lipoprotein concentrations were otherwise similar in the two groups of patients. The serum level of Lp(a) after renal transplantation may be influenced by the choice of immunosuppressive therapy.
冠心病（CHD）在慢性肾功能衰竭患者中更为常见，并且是肾移植后死亡的主要原因。血清脂蛋白（a）[Lp（a）]水平升高是普通人群中已知的冠心病危险因素，据报道肾移植受者的Lp（a）水平会升高。有人提出环孢素可能会提高Lp（a）水平。因此，我们测量了50名仅接受环孢素作为免疫抑制治疗的肾移植受者以及50名接受硫唑嘌呤和泼尼松龙治疗但未使用环孢素的肾移植受者的血清Lp（a）浓度。这些患者来自两个肾移植中心，一个中心尽可能单独使用环孢素作为免疫抑制治疗，另一个中心许多开始使用硫唑嘌呤和泼尼松龙的患者仍继续使用这种药物而非环孢素。每组患者在年龄和性别上进行了匹配，但未接受环孢素治疗的患者移植后的时间更长。两组患者的移植功能、肥胖情况和肾病的潜在病因相似。环孢素单一疗法组的Lp（a）浓度中位数为32.0（范围<0.8 - 140.3）mg/dl，显著高于硫唑嘌呤和泼尼松龙组的18.3（范围<0.8 - 167.7）mg/dl（p < 0.05）。接受环孢素治疗的患者血清高密度脂蛋白（HDL）胆固醇浓度为1.24±0.39 mmol/l（平均值±标准差），显著低于接受硫唑嘌呤和泼尼松龙治疗的患者，后者为1.41±0.40 mmol/l（p < 0.05）。接受环孢素治疗的患者HDL水平较低是由于HDL2亚组分减少。两组患者的血清脂质和脂蛋白浓度在其他方面相似。肾移植后血清Lp（a）水平可能受免疫抑制治疗选择的影响。
