von Ahsen N, Helmhold M, Schütz E, Eisenhauer T, Armstrong V W, Oellerich M
Abteilung Klinische Chemie, Zentrum Innere Medizin, Georg August Universität Göttingen, Germany.
Ther Drug Monit. 1997 Apr;19(2):140-5. doi: 10.1097/00007691-199704000-00004.
In a prospective study over 6 months, the relationship between serum lipid parameters and CsA whole blood trough concentrations was investigated in 39 renal transplant recipients receiving a triple immunosuppressive therapy with cyclosporin (CsA), azathioprine and prednisone. CsA trough concentrations were measured with a selective monoclonal immunoassay (Abbott TDx). Six months after transplantation, significant positive correlations were observed between the CsA trough concentration and serum concentrations of triglycerides (r = 0.448, p < 0.01), total cholesterol (r = 0.360, p < 0.05), and apoB (r = 0.418, p < 0.01). After exclusion of patients with over hypertriglyceridemia (> 400 mg/dl), however, the associations were no longer significant. HDL-cholesterol (HDL-C) and apo AI concentrations showed significant inverse correlations with the CsA trough level (HDL-C: r = -0.427, p < 0.01; apoAI: r = -0.350, p < 0.05); the correlations with the CsA trough level were still significant (HDL-C: r = -0.379, p < 0.05; apoAI: r = -0.354, p < 0.05) after exclusion of patients with triglyceride levels of > 400 mg/dl. As a result of these divergent effects on the plasma lipids and lipoproteins, there was a strong positive association (r = 0.633, p < 0.001) between the CsA trough concentration and the total cholesterol/HDL-C ratio. Consequently, elevated total cholesterol/HDL-C ratios that represent an increased atherogenic risk tended to be associated with higher CsA trough levels. In monitoring CsA therapy of renal transplant recipients on maintenance immunosuppressive therapy, it may well be advisable to adjust CsA dosages to obtain CsA trough levels within the lower therapeutic range for patients with an unfavorably high TC/HDL-C ratio.
在一项为期6个月的前瞻性研究中，对39名接受环孢素（CsA）、硫唑嘌呤和泼尼松三联免疫抑制治疗的肾移植受者，研究了血清脂质参数与CsA全血谷浓度之间的关系。CsA谷浓度采用选择性单克隆免疫测定法（雅培TDx）进行测量。移植后6个月，观察到CsA谷浓度与甘油三酯血清浓度（r = 0.448，p < 0.01）、总胆固醇（r = 0.360，p < 0.05）和载脂蛋白B（r = 0.418，p < 0.01）之间存在显著正相关。然而，排除高甘油三酯血症患者（> 400 mg/dl）后，这些关联不再显著。高密度脂蛋白胆固醇（HDL-C）和载脂蛋白AI浓度与CsA谷水平呈显著负相关（HDL-C：r = -0.427，p < 0.01；载脂蛋白AI：r = -0.350，p < 0.05）；排除甘油三酯水平> 400 mg/dl的患者后，与CsA谷水平的相关性仍然显著（HDL-C：r = -0.379，p < 0.05；载脂蛋白AI：r = -0.354，p < 0.05）。由于对血浆脂质和脂蛋白的这些不同影响，CsA谷浓度与总胆固醇/HDL-C比值之间存在强正相关（r = 0.633，p < 0.001）。因此，代表动脉粥样硬化风险增加的总胆固醇/HDL-C比值升高往往与较高的CsA谷水平相关。在监测接受维持性免疫抑制治疗的肾移植受者的CsA治疗时，对于总胆固醇/HDL-C比值不利地高的患者，调整CsA剂量以使其谷水平处于较低治疗范围内可能是明智的。
