Granot E
Department of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.
Hepatology. 1998 Jan;27(1):175-80. doi: 10.1002/hep.510270127.
Hyperlipidemia is frequently observed in patients who undergo renal, cardiac, bone marrow, or liver transplantation, and its contribution to the long-term morbidity and survival of patients with organ transplants may be substantial. In the few studies that have focused on the pediatric age group, findings have been inconsistent. The lipoprotein profile of 10 children after liver transplantation was characterized and compared with those in normal population controls and 10 healthy siblings. Plasma triglyceride and cholesterol concentrations were determined, lipoprotein fractions (very-low-density lipoprotein [VLDL], low-density lipoprotein [LDL], and high-density lipoproteins [HDL2 and HDL3]) were isolated, their chemical compositions were analyzed (protein, phospholipids, triglycerides, free cholesterol, and cholesteryl ester), and the percent relative weight composition of the particles was calculated. Plasma triglyceride and VLDL cholesterol levels were higher post-liver transplantation (P < .05): triglycerides (mean +/- SD), 115.1 +/- 58.7 mg% versus 76.6 +/- 20.9 mg% in siblings and 60.0 +/- 25.0 mg% in normal population controls; very-low-density lipoprotein cholesterol (VLDL-C), 23.0 +/- 11.7 mg% versus 15.3 +/- 4.7 mg% and 13.0 +/- 8.0 mg%, respectively. Plasma triglyceride levels did not correlate with the length of the period after liver transplantation. Levels of LDL-C and total HDL-C and the relative weight composition of VLDL, LDL, HDL2, and HDL3 particles did not differ between post-liver transplantation children and controls. Posttransplantation, levels of HDL3, the normally predominant HDL subfraction, were decreased relative to HDL2 levels (HDL3, 1.3; HDL2, 2.3). Because this observed relative increase in larger cholesteryl ester-rich HDL particles (HDL2) may result from inhibition of cholesteryl ester-triglyceride transfer processes, cholesteryl ester transfer protein activity was assayed. Cholesteryl ester transfer protein activity did not differ between patients and controls. Thus, the lipoprotein changes observed in children post-liver transplantation are mild hypertriglyceridemia and a significant increase in HDL2 relative to HDL3. Because HDL2 is regarded as protective against atherosclerosis, this may be of clinical relevance.
高脂血症在接受肾、心脏、骨髓或肝移植的患者中经常出现，其对器官移植患者长期发病率和生存率的影响可能很大。在少数针对儿童年龄组的研究中，结果并不一致。对10例肝移植后儿童的脂蛋白谱进行了特征分析，并与正常人群对照组和10名健康同胞的脂蛋白谱进行了比较。测定了血浆甘油三酯和胆固醇浓度，分离了脂蛋白组分（极低密度脂蛋白[VLDL]、低密度脂蛋白[LDL]和高密度脂蛋白[HDL2和HDL3]），分析了它们的化学组成（蛋白质、磷脂、甘油三酯、游离胆固醇和胆固醇酯），并计算了颗粒的相对重量组成百分比。肝移植后血浆甘油三酯和VLDL胆固醇水平较高（P <.05）：甘油三酯（均值±标准差），肝移植后儿童为115.1±58.7mg%，同胞为76.6±20.9mg%，正常人群对照组为60.0±25.0mg%；极低密度脂蛋白胆固醇（VLDL-C），分别为23.0±11.7mg%、15.3±4.7mg%和13.0±8.0mg%。血浆甘油三酯水平与肝移植后的时间长度无关。肝移植后儿童与对照组之间的LDL-C和总HDL-C水平以及VLDL、LDL、HDL2和HDL3颗粒的相对重量组成没有差异。移植后，通常占主导地位的HDL亚组分HDL3的水平相对于HDL2水平降低（HDL3为1.3；HDL2为2.3）。由于观察到的富含胆固醇酯的较大HDL颗粒（HDL2）相对增加可能是由于胆固醇酯-甘油三酯转移过程受到抑制，因此对胆固醇酯转移蛋白活性进行了测定。患者和对照组之间的胆固醇酯转移蛋白活性没有差异。因此，肝移植后儿童中观察到的脂蛋白变化是轻度高甘油三酯血症以及相对于HDL3而言HDL2显著增加。由于HDL2被认为对动脉粥样硬化有保护作用，这可能具有临床意义。
