The effect of calcineurin inhibitors on endothelial function in renal transplant recipients
The effect of calcineurin inhibitors on endothelial function in renal transplant recipients
复制标题
钙调神经磷酸酶抑制剂对肾移植受者内皮功能的影响
作者：
H. Oflaz;A. Turkmen;R. Kazancioglu;S. Kayacan;B. Bunyak;H. Gençhallaç;B. Erol;F. Mercanoğlu;S. Umman;M. Sever
摘要： 血管内皮细胞功能障碍具有重要意义，可导致多个器官的缺血和功能障碍。尽管在终末期肾病(ESRD)患者中这个问题已经有了很好的记录，但在肾移植后考虑这个问题的数据还不够多。肾移植受者内皮功能障碍的潜在原因之一可能是应用钙调神经磷酸酶抑制剂。本研究的目的是评价两种不同的钙调神经磷酸酶抑制剂[环孢素A(CsA)和他克莫司(FK506)]对肾移植患者内皮功能的影响。44例肾移植受者[FK506组22例(I组)和CsA组22例(II组)]进行了研究。应用高分辨率血管超声评价肱动脉内皮功能。分别通过建立反应性充血和舌下含服硝酸甘油(NTG)来评估内皮依赖性和非依赖性血管扩张。结果以与基准值的百分比变化表示。接受CsA治疗的肾移植患者存在显著的内皮功能障碍。而内皮依赖性血管扩张，I组为12.1 ± 5.1%，II组为6.5 ± 3.7%(p <； 0.001)。舌下含服NTG后，I组和II组的肱动脉内径分别增加了20.1 ± 6.3和12.7 ± 5.6%。这表明服用FK506的患者比服用CsA的患者更好地保存了内皮依赖性和非依赖性的血管扩张。反应性充血期I组和II组的血流量增加分别为51.2 ± 39.4和43.9 ± 24.3%(p >； 0.05)。肾移植受者术后病程伴有内皮功能障碍。这一问题在接受CsA治疗的患者中更为突出，这可能使这些患者更容易出现更频繁的心脏并发症。
Abstract: Endothelial dysfunction is of vital importance, as it may cause ischemia and dysfunction in various organs. Despite, this problem has been well documented in patients with end‐stage renal disease (ESRD), there is not enough data considering this issue following renal transplantation. One of the potential causes of endothelial dysfunction in renal transplant recipients may be administration of calcineurin inhibitors. The aim of this study is to evaluate the effects of two different calcineurin inhibitors [cyclosporin A (CsA) and tacrolimus (FK506)] on endothelial function in renal transplant patients. Forty‐four renal transplant recipients [22 on FK506 (group I) and 22 on CsA (group II)] were studied. Endothelial functions of the brachial artery were evaluated by using high resolution vascular ultrasound. Endothelium‐dependent and ‐independent vasodilations were assessed by establishing reactive hyperemia and using sublingual nitroglycerine (NTG), respectively. Results are presented as percentage change from baseline values. Significant endothelial dysfunction was noted in renal transplant patients treated with CsA. While endothelium‐dependent vasodilation was 12.1 ± 5.1% in group I and it was 6.5 ± 3.7% in group II (p < 0.001). The increase in brachial artery diameter after sublingual NTG was 20.1 ± 6.3 and 12.7 ± 5.6% in groups I and II, respectively. This indicates that the endothelium‐dependent and ‐independent vasodilation of the patients on FK506 is better preserved than the patients on CsA therapy. Besides, blood flow volume (BFV) increase was 51.2 ± 39.4 and 43.9 ± 24.3%, in groups I and II, respectively, in reactive hyperemia period (p > 0.05). Post‐transplant course of renal transplant recipients is complicated by endothelial dysfunction. This problem is more prominent in patients on CsA therapy, which can predispose these patients to more frequent cardiac complications.