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肾移植术后血脂代谢异常的危险因素及治疗进展
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Abstract:
血脂代谢异常是肾移植术后常见的并发症，可导致心血管疾病，严重影响患者及移植物存活。肾移植术后免疫抑制剂的使用可能是导致血脂异常的主要原因。降脂的目标为低密度脂蛋白胆固醇，他汀类药物为一线降脂药物，其次是与依折麦布联合使用。然而，应考虑他汀类药物与免疫抑制剂之间的药物相互作用。一些新型降脂药物，如PCSK9抑制剂、血管生成素样蛋白3 (ANGPTL3)和载脂蛋白C3 (apoC3)抑制剂，可有效降低低密度脂蛋白胆固醇和心血管疾病风险，并可能成为对他汀类药物耐药或不耐受的肾移植受者有前景的降脂方案。本文就肾移植术后血脂紊乱的危险因素、当前及未来治疗进展作一综述。
Dyslipidemia is a common complication after kidney transplantation, which can lead to cardiovascular disease and seriously affect patient and graft survival. The use of immunosuppressive drugs after kidney transplantation may be the main cause of dyslipidemia. The target for lipid lowering is LDL cholesterol, and statins are first-line lipid-lowering agents, followed by combination with ezetimibe. However, drug interactions between statins and immunosuppressants should be considered. Some novel lipid-lowering agents, such as PCSK9 inhibitors, angiopoietin-like protein 3 (ANGPTL3) and apolipoprotein C3 (apoC3) inhibitors, are effective in lowering LDL cholesterol and cardiovascular disease risk and may be promising lipid-lowering regimens for kidney transplant recipients who are resistant or intolerant to statins. This article provides a review of risk factors, current and future therapeutic advances in dyslipidemia after kidney transplantation.
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