Effects of sirolimus on lipids in renal allograft recipients: An analysis using the Framingham risk model
Effects of sirolimus on lipids in renal allograft recipients: An analysis using the Framingham risk model
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DOI：
10.1034/j.1600-6143.2002.20610.x
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发表时间：
2002-07-01
影响因子：
8.8
通讯作者：
Blum, CB
中科院分区：
文献类型：
--
作者：
Blum, CB
本报告描述了西罗莫司对血脂的影响，并使用弗雷明汉风险模型来评估这些影响的临床重要性。对 1295 名肾移植患者的两项大型对照研究的血脂数据进行了回顾性分析。将西罗莫司 2 mg/天和 5 mg/天与安慰剂或硫唑嘌呤进行比较，并与类固醇和环孢菌素同时给药超过 12 个月。所有治疗组均出现高胆固醇血症和高甘油三酯血症，并在 23 个月时达到最高。西罗莫司组的血脂水平高于对照组，但随着时间的推移，升高程度逐渐降低。 1 年时，每天服用西罗莫司 2 mg 的患者的平均胆固醇水平比对照组高 17 mg/dL，平均甘油三酯水平比对照组高 59 mg/dL。在每天服用西罗莫司 5 mg 的患者中，平均胆固醇比对照组高 30 mg/dL，平均甘油三酯比对照组高 103 mg/dL。在接受西罗莫司治疗的患者中，他汀类药物和贝特类药物治疗分别能有效降低胆固醇和甘油三酯水平。 Framingham 风险模型预测，胆固醇升高 17 mg/dL 将使冠心病 (CHD) 发病率每年每 1000 人增加 1.5 个新病例，每年每 1000 人导致 CHD 死亡增加 0.7 个事件。在接受西罗莫司治疗的患者中观察到的血脂升高是可控的，随着时间的推移有所改善，并对降脂治疗有反应。根据弗雷明汉风险模型，与移植人群的基线风险相比，与这些胆固醇升高相关的冠心病风险很小。
This report describes the effects of sirolimus on plasma lipids, and uses the Framingham risk model to assess the clinical importance of these effects. Lipid data from two large controlled studies of 1295 renal transplant patients were analyzed retrospectively. Sirolimus 2 mg/day and 5 mg/day were compared with placebo or azathioprine, and administered concomitantly with steroids and cyclosporine over 12 months.Hypercholesterolemia and hypertriglyceridemia occurred in all treatment groups and were maximal at 23 months. The sirolimus groups evidenced higher lipid levels than the controls, but the elevations diminished over time. At 1 year, the patients given sirolimus 2 mg/day had a mean cholesterol level 17 mg/dL greater and a mean triglyceride level 59 mg/dL greater than the controls. Among the patients given sirolimus 5 mg/day, mean cholesterol was 30 mg/dL greater and mean triglycerides were 103 mg/dL greater than the controls. Treatment with statins and fibrates was effective in reducing cholesterol and triglyceride levels, respectively, in the sirolimus-treated patients. The Framingham risk model predicted that the 17 mg/dL elevation in cholesterol would increase the incidence of coronary heart disease (CHD) by 1.5 new cases per 1000 persons per year and CHD death by 0.7 events per 1000 persons per year.Lipid elevations observed in the sirolimus-treated patients were manageable, improved over time, and responded to lipid-lowering therapy. Based on the Framingham risk model, the CHD risks associated with these cholesterol elevations are small compared with the baseline risks of the transplant population.