Atherosclerotic vascular complications in diabetic transplant candidates.
Atherosclerotic vascular complications in diabetic transplant candidates.
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糖尿病移植候选人的动脉粥样硬化血管并发症。
DOI：
10.1016/s0272-6386(97)90344-9
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Thomas,W
中科院分区：
文献类型：
--
作者：
Manske,CL;Wilson,RF;Wang,Y;Thomas,W
严重的血管并发症限制了糖尿病患者肾移植的成功。近一半的糖尿病移植受者在移植后3年内死于血管并发症。然而，在移植前很难确定哪些患者可能表现不佳。由于动脉粥样硬化是一种全身性疾病，我们假设移植前患有冠状动脉疾病的糖尿病移植候选者即使在移植前评估时无症状，也有发生血管并发症的高风险。我们的假设是，移植前冠状动脉造影确定患有冠状动脉疾病的胰岛素依赖型（IDDM）移植候选人在随访3年内血管事件（截肢、脑血管意外[Cva]或心肌梗死[MI]）的数量增加。我们前瞻性地研究了198例连续的糖尿病移植候选者，根据冠状动脉疾病分组。第1组患者没有50%或以上的狭窄，第2组患者有一处或多处狭窄在50%和74%之间，第3组患者有一处或多处狭窄在75%或以上。在41个月的中位随访期间，64名患者经历了98次截肢，28次MI和7次CVA。在36个月随访时，第3组患者中有55%、第2组患者中有30%和第1组患者中有11%发生了血管事件（P <0.001）。考克斯回归证实了冠状动脉疾病与随后的血管事件的相关性。冠状动脉疾病患者截肢的风险增加了7倍，心肌梗死的风险增加了4倍。7例CVA中有6例发生在冠心病患者中。我们的结论是，在移植前评估时发现的冠状动脉疾病与评估后3年内非冠状动脉血管并发症的风险增加相关。
Serious vascular complications limit the success of renal transplantation in diabetic patients. Nearly half of diabetic transplant recipients die within 3 years after transplantation from a vascular complication. However, it has been difficult to determine before transplantation which patients are likely to do poorly. Because atherosclerosis is a systemic disease, we hypothesized that diabetic transplant candidates with pretransplant coronary artery disease would be at high risk for vascular complications even if asymptomatic at the time of pretransplant evaluation. Our hypothesis was that insulin-dependent (IDDM) transplant candidates with coronary artery disease identified with pretransplant coronary angiography would have an increased number of vascular events (amputation, cerebral vascular accident [Cva], or myocardial infarction [MI]) within 3 years of follow-up. We prospectively studied 198 consecutive diabetic transplant candidates grouped on the basis of coronary artery disease. Group 1 patients had no stenosis that was 50% or greater, group 2 patients had one or more stenoses between 50% and 74%, and group 3 patients had one or more stenoses of 75% or greater. During median follow-up of 41 months, 64 patients experienced 98 amputations, 28 MIs, and seven CVAs. At 36 months of follow-up, 55% of group 3 patients, 30% of group 2 patients, and 11% of group 1 patients had experienced a vascular event (P < 0.001). Cox regression confirmed the association of coronary artery disease with subsequent vascular events. Patients with coronary artery disease had a sevenfold increased risk of amputation and a fourfold increased risk of myocardial infarction. Six of seven CVAs occurred in patients with coronary artery disease. We conclude that coronary artery disease identified at pretransplant evaluation is associated with an increased risk of noncoronary vascular complications within 3 years after evaluation.
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DOI：
--
发表时间：
1986
期刊：
影响因子：
--
作者：
Jonathan D. Philipson;Barbara J. Carpenter;J. Itzkoff;T. R. Hakala;J.Thomas Rosenthal;Rodney J. Taylor;Jules B. Puschett
通讯作者：
Jules B. Puschett
影响因子：
6.2
作者：
Ramos El;B. Kasiske;S. Alexander;G. Danovitch;W. Harmon;L. Kahana;T. J. Kiresuk;J. Neylan
通讯作者：
J. Neylan
动脉疾病在糖尿病患者肾移植后发病率和死亡率中的主要作用
影响因子：
16.2
作者：
Michael J Lemmer;J. Barry
通讯作者：
J. Barry
筛查冠状动脉疾病的糖尿病移植候选者：低风险亚组的识别。
影响因子：
19.6
作者：
Manske,CL;Thomas,W;Wang,Y;Wilson,RF
通讯作者：
Wilson,RF
胰岛素依赖型糖尿病合并慢性肾功能衰竭患者的冠状动脉血运重建
DOI：
--
发表时间：
1992
期刊：
The Lancet
影响因子：
--
作者：
C. Manske;Yang Wang;T. Rector;R. Wilson;C. White
通讯作者：
C. White