Role of lipids in chronic renal allograft rejection.
Role of lipids in chronic renal allograft rejection.
复制标题
脂质在慢性肾同种异体移植排斥反应中的作用。
DOI：
10.1159/000059824
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发表时间：
1997
影响因子：
--
通讯作者：
S. Swan
中科院分区：
文献类型：
--
作者：
S. Swan
近期移植肾短期存活率的提高使人们的注意力转移到移植后晚期移植肾衰竭的治疗和预防上。新的免疫抑制方案已显著降低了急性排斥反应的发生率，并提高了1年移植物存活率。然而，这些措施并没有减少慢性排斥反应的发生率，慢性排斥反应是晚期移植失败的主要原因[1-3]。尽管术语“慢性排斥”暗示免疫机制，但非免疫因素有助于其发病机制，可能包括肾缺血性损伤、全身性高血压、超滤、环孢素肾毒性和高脂血症[4]。在不同器官中，血管变化主导慢性排斥反应的组织学图像[5-7]，并且与动脉粥样硬化的组织学图像相似[5，8，9]。鉴于脂质异常在动脉粥样硬化疾病发病机制中所起的作用已被广泛认识，血脂异常可能会导致慢性排斥反应的发生。本章将提供一个在移植后观察到的血脂异常的概述，并描述实验数据检查脂质在慢性排斥反应中的作用。本章还将概述甘油三酯、总胆固醇、高密度脂蛋白（HDL）和低密度脂蛋白（LDL）胆固醇异常在慢性肾移植排斥反应背景下的临床相关性。肾功能不全常伴有高脂血症，高脂血症的严重程度随着患者接近终末期肾病（ESRD）而加重[10-12]。然而，成功的肾移植并不能确保氮质血症相关血脂异常的缓解，因为40-80%的移植受者可能在移植后晚期表现出血清脂质浓度升高[13-16]。总胆固醇、LDL胆固醇和高胆固醇血症升高
Recent improvements in short-term renal allograft survival have shifted attention to the treatment and prevention of graft failure in the late posttransplant period. New immunosuppression protocols have dramatically reduced the incidence of acute rejection and improved 1-year graft survival rates. Such measures, however, have not reduced the incidence of chronic rejection, the leading cause of late graft failure [1–3]. Although the term ‘chronic rejection’implies immunologic mechanisms, nonimmunologic factors contribute to its pathogenesis and likely include renal ischemic injury, systemic hypertension, hyperfiltration, cyclosporine nephrotoxicity, and hyperlipidemia [4]. Vascular changes dominate the histologic picture of chronic rejection in different organs [5–7] and bear similarity to those of atherosclerosis [5, 8, 9]. Given the wellrecognized role which lipid abnormalities play in the pathogenesis of atherosclerotic disease, dyslipidemia may contribute to the development of chronic rejection. This chapter will provide an overview of lipid abnormalities observed in the posttransplant period and describe experimental data examining the role of lipids in chronic rejection. It will also outline the clinical correlations of triglyceride, total cholesterol, high-density (HDL) and low-density (LDL) lipoprotein cholesterol abnormalities in the setting of chronic renal allograft rejection.Renal insufficiency is often accompanied by hyperlipidemia which worsens in severity as one approaches end-stage renal disease (ESRD)[10–12]. Successful renal transplantation, however, does not ensure remission of azotemiaassociated dyslipidemia since 40–80% of transplant recipients may demonstrate elevated serum lipid concentrations in the late posttransplant period [13–16]. Elevations in total cholesterol, LDL cholesterol, and hypertriglyceridemia
影响因子：
19.6
作者：
SOLEZ, K;AXELSEN, RA;YAMAGUCHI, Y
通讯作者：
YAMAGUCHI, Y