肾移植患者胆固醇酯转运蛋白基因多态性与脂代谢的关系

目的 探讨肾移植患者胆固醇酯转运蛋白(CETP)基因多态性与脂代谢的关系。方法 生物化学方法检测肾移植患者移植前及移植后6～8个月时的血脂水平；多聚酶链反应-限制性片断长度(PCR-RFLP)方法检测CETP内含子1TaqⅠB与内含子8MSPⅠ位点基因多态性。结果肾移植患者移植前甘油三脂(TG)水平显著高于正常对照组，血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、脂蛋白(a)[Lp(a)]水平均显著低于正常对照组；移植后TC、TG、HDLC、LDLC、载脂蛋白(ApoB、ApoE)水平均显著高于对照组及移植前水平。肾移植患者CETP TaqⅠB与MSPⅠ位点基因型及等位基因频率的发生率与正常对照组差异无显著性。CETP TaqⅠB基因型为B1/B1的肾移植患者，移植前TG、ApoB水平显著增高，HDLC水平显著降低，移植后表现为TG水平显著增高。肾移植患者CETPMSPI位点不同的基因型间血脂水平差异无显著性。结论肾移植患者易发生高脂血症。CETP内含子TaqⅠB位点基因多态性可显著性影响肾移植患者TG水平，基因型为B1/B1的患者易发生高甘油三酯血症。     

载脂蛋白E基因多态性对肾移植前后血脂水平的影响

目的：探讨载脂蛋白(Apo)E基因多态性对肾移植患者移植前后血脂水平的影响。方法：采用聚合酶链反应-限制性片段长度技术检测105例肾移植患者ApiE基因多态性，同时测定移植前及移植后3个月、6个月、1年、1．5年时的血脂水平，并设健康志愿者对照组。结果：移植组术后3个月血脂水平即显著增高，6个月及1年时进一步升高，1．5年时有下降趋势。移植前血清胆固醇(TC)、甘油三酯(TG)高于正常者仅占2．9％、7．6％，3个月后显著增高至28．6％、46．7％，6个月时升高至40．0％、59．0％，1年时为42．9％、62．9％，显著高于移植后3个月时的水平；肾移植组与对照组在ApoE基因型、等位基因分布频率等方面的差异无显著性。ApoE基因多态性对血脂水平的影响表现为，对照组TC、TG、低密度脂蛋白胆固醇(LDLC)、ApoA1、ApoB水平依基因型ε2／2 ε2／3、ε3／3、ε3／4 ε4／4的顺序递增，高密度脂蛋白胆固醇(HDLC)则呈递减；移植组术前表现为TC、TG、LDLC水平依上述顺序递增，移植后则表现为TG、ApoE水平依此顺序递减，不同基因型间TC等指标的差异无显著性。结论:ApoE基因多态性对移植前后血脂水平有不同的影响，移植前等位基因ε4携带者的TC、LDLC、TG水平显著增高，移植后等位基因ε2携带者的TG、ApoE水平显著增高。     

血液透析患者低密度脂蛋白受体相关蛋白Rsa Ⅰ位点基因多态性对血脂水平的影响

目的 探讨血液透析患者脂代谢紊乱的临床特征及低密度脂蛋白受体相关蛋白(LRP)外显子3RsaⅠ位点基因多态性对脂代谢的影响.方法 生化方法检测血液透析患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白(Apo)A1、ApoB、ApoE及脂蛋白(Lp)(a)水平,多聚合酶链反应-限制性片断长度多态性方法( PCR - RFLP)检测LRP外显子3Rsa Ⅰ位点基因多态性.健康体检者372例作为对照组.结果 血液透析患者脂代谢紊乱主要表现为血清TG水平显著增高,HDLC水平显著降低.血清TG水平高于正常者为33％,HDLC低于正常者为10.4％.偏相关回归分析显示,TG水平与血清ALB水平、透析时体外循环血流量显著相关;HDLC与KT/V显著相关.血液透析患者高血压的发生率为73.6％,心血管疾病为25％.伴心血管疾病组TG水平显著高于无心血管疾病组,伴高血压组与无高血压组血脂水平无显著差异.LRP基因多态性分析显示,LRP外显子3基因型C/C与等位基因C发生频率较高,病例组与对照组间无显著差异.对照组基因型C/T者血清TC、TG、LDLC水平高于基因型为C/C者,后者具有显著性差异;病例组无显著差异病例组外显子3 Rsa Ⅰ位点不同基因型间血脂水平无显著差异.结论 血液透析患者脂代谢紊乱主要表现为血清TG、ApoB水平显著增高,HDLC等指标显著降低.伴心血管并发症的患者TG水平显著高于无并发症的患者.TG水平与血清ALB水平、透析时体外循环血流量显著相关;HDLC与KT/V显著相关.LRP外显子3 Rsa Ⅰ位点基因多态性对正常人群与血液透析患者血脂水平有不同的影响.     

血液透析患者低密度脂蛋白受体相关蛋白基因多态性与血脂水平检测

目的 探讨血液透析患者脂代谢紊乱的临床特征及低密度脂蛋白受体相关蛋白(LRP)基因多态性对脂代谢的影响。方法 生化方法检测血液透析血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白(Apo)A1、ApoB、ApoE及脂蛋白(Lp)(a)水平，多聚合酶链反应-限制性片断长度(PCR-RFLP)方法检测LRP5′端四核苷酸重复序列及外显子3 RsaⅠ位点基因多态性。结果 血液透析患者脂代谢紊乱主要表现为血清TG水平显著增高，高于正常者33．0％，HDLC水平显著降低，低于正常者10．4％。偏相关回归分析显示，TG水平与血清ALB水平、透析时体外循环血流量显著相关；HDLC与KT／V显著相关。血液透析患者高血压的发生率为73．6％，心血管疾病发生率为25．0％。伴心血管疾病组TG水平显著高于无心血管疾病组，伴高血压组与无高血压组血脂水平无显著差异。LRP基因多态性分析显示，LRP 5′端基因型91／91、91／187与等位基因91bp频率较高，LRP外显子3基因型C/C与等位基因C发生频率较高，病例组与对照组间无显著差异。病例组LRP5′端四核苷酸重复序列与外显子3 RsaⅠ位点不同基因型间血脂水平无显著差异。结论 血液透析患者脂代谢紊乱主要表现为血清TG、ApoB水平显著增高，HDLC等指标显著降低。伴心血管并发症的患者TG水平明显高于无并发症的患者。TG水平与血清ALB水平、透析时体外循环血流量显著相关；HDLC与KT／V显著相关。LRP5′端四核苷酸重复序列与外显子3 RsaⅠ位点基因多态性，对血液透析患者血脂水平无显著影响。     

肾移植患者的血脂改变

目的 研究肾移植患者的血脂变化。方法 对上海市8家医院174例肾移植的资料进行调查分析。结果 与正常对照组相比，肾移植患者术前血胆固醇（Tch)、低密度脂蛋白胆固醇（LDL－ch)显著增高，血甘油三酯（TG）、高密度脂蛋白胆固醇（HDL－ch)、极低密度脂蛋白胆固醇（VLDL－ch)与正常对照组的差异无显著性；载脂蛋白Al(Apo A1)及卵磷脂胆固醇酰基转移酶（LCAT）均低于正常对照组，脂蛋白（a)[Lp(a)]的水平显著高于正常对照组；肾移植患者手术前后上述各指标的变化不显著。结论 肾移植患者脂质紊乱相当常见，应高度重视。     

肾移植术后血脂的变化对移植肾功能的影响

目的:探讨肾移植患者血脂代谢情况及其对移植肾功能的影响。方法:检测89例肾移植患者肾移植前、后的血脂水平,并与移植后1年内发生急性排斥反应及移植后1年时发生慢性移植肾功能不全的患者进行血清肌酐水平相关性分析。结果:与正常对照组比较,肾移植前、后的血清总胆固醇、低密度脂蛋白胆固醇的水平显著升高(P<0.01),甘油三酯、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇水平无显著差异。血载脂蛋白A1水平显著低于正常对照组(P<0.01)。移植前、后上述血脂水平无显著差异。移植前高胆固醇血症与急性排斥反应的发生存在相关性,高胆固醇血症对慢性移植肾功能不全患者血清肌酐水平升高存在影响。结论:肾移植患者血脂代谢紊乱明显不同于正常人群,高脂血症对急性排斥反应及慢性移植肾功能不全的发生具有不良影响。     

上海地区透析患者血脂改变的调查

目的：了解连续性不卧床腹膜透析（CAPD）和维持性血液透析（MHD）患者血脂水平改变,方法：对CAPD和MHD患者血脂水平进行横断面调查,前瞻性观察CAPD和MHD对患者血脂的影响,结果：CAPD和MHD患者血甘油三酯(TG）和载脂蛋白B（apoB)均显著增高,血高密度脂蛋白胆固醇(HDL-ch),HDL2,apoA1和卵磷脂酰基胆固醇转移酶（LCAT）均显著低于正常,以上指标在血,腹透组之间差异无显著性意义,CAPD组血浆脂蛋白（Lp)(a)水平显才高于正常组和MHD组,CAPD治疗后,患者血Lp(a),apoE,LDL-ch和spoB水平显著升高,血透后仅apoE和apoB水平明显升高,结论：ＣＡＰＤ和ＭＨＤ患者脂代谢紊乱相当常见,以前者更为突出。     

血管紧张素转换酶2和血管紧张素转换酶基因多态性与妊娠糖尿病孕妇及正常孕妇血脂水平的相关性研究

目的探讨血管紧张素转换酶2（ACE2）单核苷酸多态性位点rs2285666和rs2106809及血管紧张素转换酶（ACE）插入／缺失（I／D）多态性与妊娠糖尿病（GDM）孕妇及正常孕妇妊娠中晚期血脂水平的相关性。方法选取GDM孕妇344例,糖耐量正常（NOT）孕妇417例。采用聚合酶链反应（PCR）及聚合酶链反应-限制性片断长度多态性（PCR—RFLP）方法检测ACE2及ACE基因多态性,并于孕24～28周留取受试者空腹静脉血检测总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDLC）、低密度脂蛋白胆固醇（LDLC）、载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB）和脂蛋白a[Lp（a）]水平。结果GDM和NGT两组间ACE2 rs2285666、rs2106809和ACE I／D基因型及等位基因分布频率均无统计学差异（P〉0．05）。GDM患者的TG水平显著高于NGT孕妇[（2．69±0．95）mmol／L vs（2．38±0．81）mmol／L]（P〈0．05）,HDLC水平显著低于NGT孕妇[（2．11±0．46）mmol／L vs（2．20±0．43）mmol／L]（P〈0．05）。将受试者按ACE2 rs2285666、rs2106809ACE和ACE I／D基因型分组,ACE DD基因型组TC、LDLC水平高于ACEⅡ组,分别为（6．33±1．09）mmol／L vs（6．05＋0．96）mmol／L、（3．62±0．89）mmol／L vs（3．39±0．79）mmol／L（P〈0．05）,进一步将受试者分别按ACE I／D基因型分组,NGT组DD基因型受试者TC和LDLC水平明显高于Ⅱ基因型组,分别为（6．46±1．20）mmol／L vs（6．06±0．95）mmol／L和（3．73±1．03）mmol／L vs（3．43±0．77）mmol／L（P〈0．05）,而GDM组各基因型组之间各血脂水平无显著差异。结论ACE I／D多态性与孕妇孕中晚期血脂水平有关,NGT组DD基因型孕妇比Ⅱ基因型孕妇的TC、LDL水平高,GDM可能也存在ACE I／D多态性对孕妇妊娠中晚期血脂水平的影响。     

血脂及血管内皮功能异常在糖尿病肾脏病发病中的意义

目的 研究血脂及血管内皮功能异常在糖尿病肾脏病发病学中的意义。方法选择2008年1月至2008年12月在我院住院的糖尿病。肾脏病患者40例,为糖尿病肾脏病组（D组）,同时选择同期40名健康者,为对照组（N组）。采用PAP酶法测定2组血清总胆固醇（TC）、三酰甘油（TG）,直接法测定血清高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDLC）,免疫比浊法测定脂蛋白（a）[Lp（a）],采用放射免疫分析法测定血浆内皮素1（ET-1）,硝酸还原法测定一氧化氮（NO）。结果与N组相比,D组TC、TG、LDL-C、Lp（a）、ET-1升高（P＜0．05）,HDL-C、NO降低（P〈0．05）。结论血脂紊乱和血管内皮功能异常在糖尿病肾脏病发病中起重要作用。     

血液透析患者脂代谢紊乱的临床研究

目的探讨血液透析患者脂代谢紊乱的临床特征及原因。方法检测106例维持性血液透析患者空腹血脂，并对影响血脂水平及有关因素进行分析。结果血液透析患者脂代谢紊乱主要表现为血清甘油三脂（TG）、载脂蛋白B（Apo-LB）水平显著增高，高密度脂蛋白胆固醇（HDLC）显著降低。TG与血清白蛋白（Alb）、透析时体外循环血流量显著负相关（r=-0．398，r=-0．219）；HDLC水平与Kt／V显著相关（r=-0．305）。血液透析患者高血压的发生率为73．6％，心血管病变为25％。伴心血管疾病的血液透析患者TG水平显著高于无心血管疾病者。结论血液透析患者脂代谢紊乱主要表现为TG、Apo-LB水平增高，HDLC水平降低。透析充分及透析时体外循环血流量及血清白蛋白水平影响血脂水平。     

Effect of Apolipoprotein E Gene Polymorphism on Serum Lipid Level Before and After Renal Transplantation

Objective

To investigate the effect of apolipoprotein E (ApoE) gene polymorphism on lipid metabolism among renal transplant recipients before and after transplantation. No prisoners or organs from prisoners were used in this study.

Methods

ApoE gene polymorphism was detected with polymerase chain reaction-restriction fragment length polymorphism; serum lipid levels were measured with biochemical methods.

Results

Serum lipid levels in the recipients were increased significantly at 3 months after renal transplantation, and further elevated at 6 months and 1 year. The recipients with higher total serum cholesterol (TC) and triglyceride (TG) levels only accounted for 2.9% and 7.6%, respectively, before renal transplantation; but for 28.6% and 46.7%, respectively, at 3 months (P < .01); 40.0% and 59.0% at 6 months; and 42.9% and 62.9% at 12 months. ApoE gene polymorphism showed no statistical difference in ApoE allele or ApoE genotype between the control and the study groups. The effect of ApoE genotype on serum lipid levels was different between controls and recipients either before or after renal transplantation. The levels of serum TC, TG, low-density lipoprotein cholesterol, ApoB, ApoE were: ^ε2/2+^ε2/3; ^ε3/3; ^ε3/4+^ε4/4 from low to high in controls and recipients before transplantation, but the levels of TG and ApoE reversed among recipients after renal transplantation.

Conclusion

Renal transplant recipients are liable to develop hyperlipidemia, particularly hypertriglyceridemia among recipients with ApoE genotypes ^ε2/2 or ^ε2/3.     

Effects of immunosuppressive drugs on serum lipid levels in renal transplant recipients

BACKGROUND: Hyperlipidemia is an important metabolic disorder that is common among renal transplant recipients. This study investigated the possible effects of transplantation and immunosuppressive drugs on lipid profiles in this patient group. METHODS: We retrospectively evaluated the records of 179 patients who underwent renal transplantation between 1996 and 2000, recording lipid profile findings-total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), and triglyceride (TG)-before and at least 6 months after transplantation. We also recorded patient demographics, underlying renal disorder, and immunosuppressive drug regimens. RESULTS: Sixty-nine (38.5%) patients were women and 110 men (61.5%). The mean age (+/- SD) of the 179 recipients was 35.7 +/- 11.8 years (range, 11 to 62 years). The respective pre- versus posttransplantation lipid profile findings were: TC, 171.6 +/- 42.4 mg/dL versus 204.7 +/- 45.3 mg/dL, P < .001; LDLc, 114.5 +/- 34.5 mg/dL versus 142.2 +/- 39.7 mg/dL, P < .001; HDLc, 46.7 +/- 13.6 mg/dL versus 42.5 +/- 12.3 mg/dL, P = .001; TG, 142.9 +/- 55.7 mg/dL versus 178.8 +/- 71.8 mg/dL, P < .001. Increased lipid levels were found to be independent of patient age, sex, donor type, and immunosuppressive drug regimen. CONCLUSION: The results suggested that antihyperlipidemic drugs should be administered routinely to renal transplant recipients irrespective of the immunosuppressive drug regimen or graft source.     

Long term efficacy of simvastatin in renal transplant recipients treated with cyclosporine or tacrolimus

BACKGROUND: Hyperlipidemia is frequently developed following renal transplantation and results in worsening of the patient's prognosis. METHODS: In this study, 14 patients who had hypercholesterolemia [total cholesterol (TC) >200 mg/dL] and hypertriglyceridemia [triglyceride (TG) >150 mg/dL] 1 month after renal transplantation (post-transplantation), seven patients each under the treatment with immunosuppressant, either cyclosporine or tacrolimus started simvastatin treatment of 5-10 mg/d and continued the treatment for 4 yr. The effect of simvastatin treatment was assessed by comparison in serum lipid levels (TC, TG, cholesterol in lipoprotein fractions, and apolipoproteins) and the lipid metabolism related enzyme activities for post-transplantation, after 6-month and 4-yr simvastatin treatment. RESULTS: Simvastatin treatment of 4 yr significantly decreased the elevated levels of serum TC from 234.5 +/- 30.8 to 186.3 +/- 20.5 mg/dL (p < 0.001), low density lipoprotein cholesterol (LDL-C) from 116.7 +/- 22.5 to 82.7 +/- 16.6 mg/dL (p < 0.05) and TG from 200.3 +/- 109.2 to 97.0 +/- 45.2 mg/dL (p < 0.001). In addition, there were significant decreases in elevated serum very-low-density lipoprotein cholesterol (VLDL-C) from 47.8 +/- 18.4 to 28.6 +/- 9.5 mg/dL (p < 0.001) and LDL2 cholesterol (LDL2-C) from 20.8 +/- 8.2 to 5.7 +/- 1.8 mg/dL (p < 0.001). CONCLUSION: The results indicate that 4-yr treatment of simvastatin improves profiles of the atherogenic lipids in renal transplant patients with immunosuppressant caused hypercholesterolemia and hypertriglyceridemia treated either cyclosporine or tacrolimus in similar manner.     

肾移植受者术后早期血脂异常的趋势——北京地区多中心调查分析

目的 了解肾移植受者术后早期血脂异常的趋势、相关发病因素及其对移植肾功能的影响.方法 收集2004-2008年间在北京地区8所医院肾移植中心接受肾移植的1032例临床资料,分析术前以及术后1、3、6和12个月的血总胆同醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)的变化趋势,按时间段分层分析不同阶段、不同年龄组血脂异常的差异,免疫抑制剂对血脂的影响,以及血脂异常对血肌酐的影响.结果 除HDL-C以外,其他3项在第1年中均呈现逐渐升高的趋势,尤以LDL-C和TG升高最为突出,TC和LDL-C异常与年龄有明显相关性(P<0.01).他克莫司为基础的免疫抑制方案对脂代谢异常的影响小于环孢素A(P<0.05).1年时降脂治疗与未治疗者之间血肌酐的差异无统计学意义(P>0.05);在未经降脂治疗的受者中,术后1个月TG高于正常者,其1年时的血肌酐明显高于TG正常者(P<0.05).结论 肾移植受者术后血脂异常较为常见,个别指标术后1个月时即升高,并持续至1年;血脂异常与年龄呈正相关;以他克莫司为基础的免疫抑制剂组合对血脂的影响较小.     

Effects of cholesteryl ester transfer protein TAQ1B polymorphism in renal transplant patients

BACKGROUND: Dyslipidemia is an important complication in renal transplant patients. Cholesteryl ester transfer protein (CETP) mediates the exchange of cholesteryl ester between high density lipoproteins and low density lipoproteins. The aim of this study was to investigate CETP Taq1B gene polymorphism and lipid abnormalities in renal transplant patients. METHODS: We studied 29 renal transplant patients and 29 healthy controls. CETP Taq1B polymorphism was determined by polymerase chain reaction and restriction fragment length polymorphism techniques. Serum lipid levels were measured enzymatically. Statistical analyses was performed by SPSS for Windows version 7.5. RESULTS: The frequencies of CETP Taq1B B1B1, B1B2, and B2B2 genotypes in patients were 44.8%, 34.5%, and 20.7%; and in control subjects, 37.9%, 37.9%, and 24.2%, respectively. The patients with B1B1 genotype displayed higher levels of total cholesterol (TC), triglycerides, low density lipoprotein-cholesterol (LDL-C), very low density lipoprotein-cholesterol (VLDL-C), and diastolic blood pressure (DBP). (P<.05). Also, patients showing a B1 allele had higher levels of TC, LDL-C, VLDL-C, and DBP compared to healthy controls (P<.05). CONCLUSION: We observed that CETP Taq1B B1 allele and B1B1 genotype have effects on the serum lipid profile among renal transplant patients.     

Genetic variations of the apolipoprotein E gene determine the plasma triglyceride levels after heart transplantation.

OBJECTIVES: To study whether the presence of the polymorphism in the apolipoprotein E (apo E) gene influences the lipid profile in heart-transplant recipients. METHODS: A cohort of 103 recipients of heart transplant (93 men and 10 women, with a mean age of 47 +/- 13 years) under triple immunosuppressive therapy were submitted to a genetic study of the apo E gene region. Anthropometric and analytical data, including lipid profile and arterial blood pressure were collected prior to transplantation and 3, 6, 12, and 24 months after it. RESULTS: 65 subjects present the genotype E3E3, 27 the genotype E3E4, 6 the genotype E2E3, and 5 the genotype E2E4. Carriers of the E2 allele (that is, genotypes E3E2 and E4E2) had higher total plasma triglyceride (TG) levels after 3 months (3.47 +/- 1.88 mmol/liter p < 0.001) and after 1 year of transplantation (3.13 +/- 1.77 mmol/liter p < 0.05) than the other genotypes. There were no differences in the plasma levels of total cholesterol (TC), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C). Multiple regression analysis revealed that the apoprotein E gene polymorphism determines 5% (p = 0.0425) and age 8.7% (p < 0.009) of the variants in TG levels. CONCLUSIONS: The presence of the E2 allele in heart-transplant recipients produces a greater rise in total TG plasma levels than the other genotypes.     

New onset dyslipidemia after renal transplantation: is there a difference between tacrolimus and cyclosporine?

Lipid abnormalities including increased total cholesterol (TC), triglycerides (TG) and low density lipoprotein cholesterol (LDL-C) have been frequently reported in renal transplantation and could be involved in the high frequency of cardiovascular diseases in this population. PATIENTS AND METHODS: Two hundred ninety-five patients were transplanted between January 1995 and October 2000 in our center. Two hundred two patients were included in this study. Seventy-six patients received tacrolimus (Tac), and 126 patients cyclosporine (CsA). Lipid parameters were assessed the day of transplantation and 1 year posttransplantation. RESULTS: Serum lipids were similar between the two groups at D0. At M12, TC and LDL-C were significantly higher in the CsA group (6.14 +/- 1.37 vs 5.28 +/- 1.32 mmol/L; P < .05 and 3.98 +/- 1.05 vs 3.26 +/- 1.03 mmol/L; P < .05 CsA vs Tac, respectively). TG were comparable in both groups (1.86 +/- 1.07 vs 1.62 +/- 0.92 mmol/L; P = .55; CsA vs Tac). Incidence of de novo hypercholesterolemia was significantly higher in the CsA group (28 vs 8%) whereas incidence of hyperTG was similar in both groups. Prevalence of LDL-C was significantly higher in the CsA group (65% vs 31%; P < .001), whereas there was no difference in high density lipoprotein (HDL)-C levels. DISCUSSION: Mean serum lipid levels and incidence and prevalence of hyperTC, especially LDL-C, was significantly higher in patients receiving CsA when compared with Tac. TG and HDL-C levels were similar. Although the study was retrospective, our results confirm that CsA increases lipid levels, whereas Tac does not. CONCLUSION: Lipid disorders are frequently observed in renal transplant recipients. CsA, but not Tac, significantly increases incidence and prevalence of high TC and LDL-C.     

Genetic variation of apolipoprotein E does not contribute to the lipid abnormalities secondary to childhood minimal change nephrotic syndrome

Minimal change nephrotic syndrome (MCNS) is a common progressive renal disorder occurring in childhood that is characterized by alterations of permselectivity at the glomerular capillary wall, resulting in its inability to restrict the urinary loss of protein. Hyperlipidemia (HLP) is not only an important clinical manifestation of MCNS but is also involved in cardiovascular disease and in progressive renal damage. ApoE is a polymorphic protein. Besides modulation of lipid metabolism, apoE can also elevate the sulfate-proteoglycan in glomerular filtration membrane and inhibit the proliferation of mesengial cells. The present study aimed mainly to determine whether genetic polymorphism of apoE is involved in the HLP secondary to childhood MCNS. Genomic DNA was extracted from 250 children diagnosed with MCNS and 200 healthy controls. ApoE genotype was determined by PCR-restriction fragment length polymorphism (RFLP) analysis. The fasting serum lipoprotein (a) [Lp(a)], total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Serum concentrations of Lp(a), TC, TG, HDL-C, nonHDL-C, LDL-C, and apoB were higher in the MCNS than in the control group (P < 0.05). No significant differences in genotypes and alleles frequencies were observed for the apoE Hha I restriction sites in MCNS patients as compared to controls (P > 0.05). No significant differences in serum lipid levels were observed for variant genotypes and alleles of apoE Hha I restriction site in both MCNS and healthy children (P > 0.05). Genetic variation of apoE does not contribute to the lipid abnormalities secondary to childhood MCNS.     

Impact of fluvastatin on hyperlipidemia after renal transplantation

BACKGROUND: Renal transplant recipients are at increased risk of atherosclerotic vascular disease with hyperlipidemia. Many recipients have preexisting cardiovascular disease at the time of transplantation, and immunosuppressive therapy may aggravate existing risk factors or promote development of new risk factors, notably hyperlipidemia and hypertension. Fluvastatin is one of the statins, an HMG-CoA reductase inhibitor, which has been shown to be effective in lowering cholesterol levels. We treated hyperlipidemia after renal transplantation with Fluvastatin for more than 6 months.We attempted to clarify the efficacy of fluvastatin on hyperlipidemia in renal transplant recipients. MATERIALS: Forty-five renal transplant recipients with hyperlipidemia were enrolled in this study. The mean age was 44.2 years, with 23 men and 22 women. Thirty-seven transplantations were from a living related donors and eight from cadaveric donors. Thirty-three recipients were ABO-compatible, seven recipients had minor mismatches, and five recipients were ABO-incompatible. The dose of fluvastatin was 20 mg per day. Levels of total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), serum creatinine (s-Cr), ALT, ALP, uric acid (UA), hematocrit (Ht), CPK, and blood pressure were examined in all recipients before treatment as well as 1, 3, and 6 months after Fluvastatin administration. RESULTS: The mean levels of TC and TG were significantly reduced from 256, to 224 and 215 mg/dL, and from 188 to 170 and 147 mg/dL at 1 and 6 months after treatment, respectively. The mean levels of HDL-C were 72 mg/dL before treatment, 81 mg/dL at 1 month, and 80 mg/dL at 6 months after treatment. The mean levels of LDL-C were 153 mg/dL before treatment, 145 mg/dL at 1 month, and 145 mg/dL at 6 months after treatment. Fluvastatin significantly produced a reduction rate in TC of 16%, TG of 22%, and LDL-C of 5% after 6 months of treatment, respectively. The mean levels of HDL-C of were increased 10% after 6 months of treatment. The serum creatinine and CPK were not significantly different. There were no clinically significant differences in other factors. No significant adverse effects were observed. CONCLUSIONS: Fluvastatin seemed to be safe and highly effective to control TC, TG, LDL-C, and HDL-C in renal transplant recipients.     

A long-term study on hyperlipidemia in stable renal transplant recipients

OBJECTIVES: Hyperlipidemia is a common and important risk factor after renal transplantation, but there is little long-term data on its incidence, pattern, and evolution in stable renal allograft recipients on low dose maintenance immunosuppression. PATIENTS AND METHODS: A retrospective study was conducted on all patients who received kidney transplants from April 1, 1990 to March 31, 2000 at a single center, on their serial lipid profile during the first 3 yr after kidney transplantation. RESULTS: A total of 221 (122 male, 99 female; mean age 37.8 +/- 10.0 yr at the time of transplantation) Chinese adult renal allograft recipients were included. A 95.3% of patients were on cyclosporine and prednisolone based immunosuppression. Increases in total cholesterol (TC), low density lipoprotein (LDL), and high density lipoprotein (HDL) were noted, while the level of triglyceride (TG) decreased after renal transplant. The incidence of hypercholesterolemia (defined as TC >/= 6.3 mmol/L or LDL >/= 4.2 mmol/L) within the first year was 28.2 and 20.3%, respectively. The incidence rate decreased significantly in the second (5.4%, p = 0.000 and 6.4%, p = 0.003) and third year (9.5%, p = 0.003 and 4.9%, p = 0.021), but the incidence of patients having a high risk-ratio (defined as TC/HDL >/= 5) remained unchanged (6.9, 4.9 and 10.3% within the first, second, and third year, respectively). Treatment with statin was necessitated in 6.8, 13.6 and 21.7% of the patients at 1, 2, and 3 yr after transplantation, respectively. The prevalence rates of elevated TC and LDL were 18.3 and 18.9% at baseline, 40.6 and 33.3% after 1 yr, 32.8 and 27.3% after 2 yr, and 24.8 and 19.0% after 3 yr, despite treatment. The prevalence of patients with a high risk-ratio was 45.0% at baseline, 30.5% after 1 yr (p = 0.002), 22.6% after 2 yr (p = 0.000) and 21.8% after 3 yr (p = 0.000). Hypercholesterolemia at the time of transplantation was an independent predictor for post-transplant hypercholesterolemia (odds ratio 3.76, 95% confidence interval 1.47-9.62, p = 0.006). CONCLUSION: Renal transplantation is associated with a characteristic pattern of dyslipidemia, with increased TC, LDL and HDL, and a decrease in TG. Patients with pre-existing hypercholesterolemia were at higher risk for post-transplant hypercholesterolemia. Although the incidence of hypercholesterolemia peaks within the first year after transplantation, this remains a long-term complication in a significant proportion of patients on low dose immunosuppressive medications.