Massy Z A, Mamzer-Bruneel M F, Chevalier A, Millet P, Helenon O, Chadefaux-Vekemans B, Legendre C, Bader C, Drüeke T, Lacour B, Kreis H
Service de Transplantation, Laboratoire de Biophysique and INSERM U90, Hôpital Necker, Paris, France.
Nephrol Dial Transplant. 1998 Jul;13(7):1792-8. doi: 10.1093/ndt/13.7.1792.
Cardiovascular accidents are the major cause of morbidity and mortality in renal transplant recipients. However, there is little information concerning carotid atherosclerotic wall changes in renal transplant recipients, their relationship with cardiovascular accidents and their possible association with cardiovascular risk factors in such patients.
Between April 1991 and December 1997, we prospectively assessed cardiovascular accidents in 79 renal transplant recipients who had received a transplant at our institution before January 1, 1986. Carotid morphology by B-mode ultrasonography, relevant clinical and laboratory cardiovascular risk factors, including lipid abnormalities and total homocyst(e)ine, were determined at the start of the follow-up period. Seventeen healthy subjects matched for age and sex with renal transplant recipients served as controls who volunteered for ultrasonographic examination of carotid arteries.
Nine patients experienced cardiovascular events during the period of follow-up. Compared with healthy, age- and sex-matched control subjects (n = 17), the frequency of carotid plaques was higher in renal transplant recipients with cardiovascular events (n = 9), but not in those without such events (n = 70). The frequency of cardiovascular accidents was related to the number of carotid plaques (4, 17 and 24% for no plaque, one plaque and > 1 plaque respectively, P < 0.04). However, by multivariate analysis, serum total cholesterol [odds ratio (OR) of 1.8 for each 1.0 mM, P < 0.07) and the presence of diabetes mellitus (OR of 28.4 for presence, P < 0.01) were the only predictors of cardiovascular events in such patients, whereas the presence of carotid plaques was not. Moreover, neither serum lipoprotein (a) nor total homocyst(e)ine concentrations could be identified as risk factors.
This prospective study shows that although a close association exists between asymptomatic carotid atherosclerosis and cardiovascular accidents in renal transplant recipients with long-term follow-up and relatively good renal function, other potentially modifiable risk factors appear to be better predictors of cardiovascular events. Consequently, the assessment of carotid atherosclerosis may not be clinically useful for the systematic identification of renal transplant recipients with an increased risk of developing cardiovascular events.
心血管意外是肾移植受者发病和死亡的主要原因。然而，关于肾移植受者颈动脉粥样硬化壁改变、其与心血管意外的关系以及与这类患者心血管危险因素的可能关联的信息很少。
在1991年4月至1997年12月期间，我们前瞻性评估了79例于1986年1月1日前在本机构接受移植的肾移植受者的心血管意外情况。在随访期开始时，通过B型超声检查颈动脉形态，测定相关临床和实验室心血管危险因素，包括脂质异常和总同型半胱氨酸。17名年龄和性别与肾移植受者匹配的健康受试者作为对照，自愿接受颈动脉超声检查。
9例患者在随访期间发生心血管事件。与健康的、年龄和性别匹配的对照受试者（n = 17）相比，发生心血管事件的肾移植受者（n = 9）颈动脉斑块的发生率更高，但未发生此类事件的肾移植受者（n = 70）并非如此。心血管意外的发生率与颈动脉斑块数量相关（无斑块、有1个斑块和有>1个斑块的发生率分别为4%、17%和24%，P < 0.04）。然而，通过多变量分析，血清总胆固醇（每增加1.0 mM的比值比（OR）为1.8，P < 0.07）和糖尿病的存在（存在时的OR为28.4，P < 0.01）是这类患者心血管事件的唯一预测因素，而颈动脉斑块的存在则不是。此外，血清脂蛋白（a）和总同型半胱氨酸浓度均不能被确定为危险因素。
这项前瞻性研究表明，尽管在长期随访且肾功能相对良好的肾移植受者中，无症状颈动脉粥样硬化与心血管意外之间存在密切关联，但其他潜在可改变的危险因素似乎是心血管事件更好的预测因素。因此，颈动脉粥样硬化的评估对于系统识别发生心血管事件风险增加的肾移植受者可能在临床上并无用处。
