Chang G, DeNofrio D, Desai S, Kelley M P, Rader D J, Acker M A, Loh E
Cardiovascular Division, Department of Medicine, University of Pennsylvania Health System, Philadelphia 19104-4024, USA.
Am Heart J. 1998 Aug;136(2):329-34. doi: 10.1053/hj.1998.v136.89581.
Elevated serum lipoprotein(a) [Lp(a)] levels are associated with the development of native coronary atherosclerosis. The association between increased levels of Lp(a) and the development of accelerated cardiac allograft vasculopathy (ACAV) in patients who have undergone orthotopic heart transplantation has not been firmly established.
We studied 74 consecutive heart transplant recipients with at least 1 year survival to determine the relation between Lp(a) and the presence of ACAV. Recipient and donor clinical and laboratory parameters, including mean serum Lp(a) levels, were obtained. ACAV was defined angiographically as > or =30% stenosis in one or more epicardial arteries. ACAV 1 year after heart transplantation was angiographically present in 26 (35%) patients. Mean donor age (36 +/- 13 years [ACAV (+)] vs 28 +/- 10 years, [ACAV (-)]; p = 0.004) and mean serum triglyceride levels 6 months after transplantation (286 +/- 275 mg/dl [ACAV (+)] vs 169 +/- 85 mg/dl [ACAV (-)]; p = 0.025) were univariate predictors of ACAV. No significant difference in mean serum Lp(a) levels was observed (20 +/- 19 mg/dl [ACAV (+)] vs 30 +/- 30 mg/dl [ACAV (-)]; p = NS). Donor age was the single greatest independent predictor of ACAV by multivariate logistic regression (p = 0.02).
Lp(a) does not appear to be a risk factor for the development of ACAV 1 year after heart transplantation. Further studies are needed to define the influence of serum Lp(a) on the development of cardiovascular disease after orthotopic heart transplantation.
血清脂蛋白(a)[Lp(a)]水平升高与天然冠状动脉粥样硬化的发生有关。Lp(a)水平升高与原位心脏移植患者加速性心脏移植血管病变(ACAV)发生之间的关联尚未明确确立。
我们研究了74例连续存活至少1年的心脏移植受者，以确定Lp(a)与ACAV存在之间的关系。获取了受者和供者的临床及实验室参数，包括平均血清Lp(a)水平。ACAV在血管造影上定义为一条或多条心外膜动脉狭窄≥30%。心脏移植1年后，26例(35%)患者血管造影显示存在ACAV。供者平均年龄(ACAV阳性组为36±13岁，ACAV阴性组为28±10岁；p=0.004)和移植后6个月的平均血清甘油三酯水平(ACAV阳性组为286±275mg/dl，ACAV阴性组为169±85mg/dl；p=0.025)是ACAV的单因素预测指标。平均血清Lp(a)水平未观察到显著差异(ACAV阳性组为20±19mg/dl，ACAV阴性组为30±30mg/dl；p=无统计学意义)。多因素逻辑回归分析显示，供者年龄是ACAV的唯一最大独立预测因素(p=0.02)。
Lp(a)似乎不是心脏移植1年后发生ACAV的危险因素。需要进一步研究来确定血清Lp(a)对原位心脏移植后心血管疾病发生的影响。
