肝移植受者降脂治疗的特点

A. A. Kucherov, A. Ershova, V. Syutkin, O. Drapkina
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引用次数: 0

摘要

肝脏移植手术(LT)不仅需要一个精心组织的系统来监测患者术后早期的状况,而且还需要在长期阶段可靠地协调不同专业医生的行动。这是由于肝移植受者的存活率提高,死亡率结构向心血管疾病转移,以及需要纠正受者经常出现的代谢并发症,尤其是高脂血症。LT术后脂质代谢紊乱的治疗包括改变生活方式、免疫抑制和降脂治疗(LLT),从而降低心血管风险。由于药物相互作用引起的潜在副作用,尤其是肌病甚至横纹肌溶解症,LT 后患者使用 LLT 受到限制。根据目前的临床指南,对肺结核患者最安全的治疗方法是普伐他汀和氟伐他汀,但这两种药物的使用受到了供应量少和疗效低的限制。依折麦布在与免疫抑制剂联合使用时具有潜在的良好耐受性,而匹伐他汀通过细胞色素 P-450 同工酶代谢,不参与免疫抑制剂的代谢,因此通过使用依折麦布和代谢中性 PCSK9 抑制剂来改善 LT 后患者的 LLT 似乎很有希望。
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Features of lipid-lowering therapy in liver transplant recipients
Liver transplantation (LT) requires not only a carefully organized system for monitoring the condition of patients in the early postoperative period, but also reliable coordination of the actions of doctors of different specialties in the long-term period. This is due to improved survival of liver transplant recipients and a shift in the mortality structure towards cardiovascular diseases and the need to correct metabolic complications that often occur in recipients, in particular hyperlipidemia. Treatment of lipid metabolism disorders after LT includes lifestyle changes, immunosuppressive and lipid-lowering therapy (LLT), which reduces cardiovascular risk. The use of LLT in patients after LT is limited by potential side effects caused by drug interactions, in particular myopathy up to rhabdomyolysis. According to current clinical guidelines, the safest treatment for patients after LT is pravastatin and fluvastatin, the use of which is limited by low availability and low efficacy. It seems promisingto improve LLT in patients after LT through the use of ezetimibe, which has a potentially favorable tolerability profile when combined with immunosuppressants, as well as pitavastatin, which is metabolized through cytochrome P-450 isoenzymes not involved in the metabolism of immunosuppressants, and metabolically neutral PCSK9 inhibitors.
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来源期刊
Cardiovascular Therapy and Prevention
Cardiovascular Therapy and Prevention Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.70
自引率
0.00%
发文量
155
审稿时长
6-12 weeks
期刊介绍: The most important objectives of the journal are: the generalization of scientific and practical achievements in the field of cardiology, increasing scientific and practical skills of cardiologists. The scientific concept of publication does the publication of modern achievements in the field of epidemiology, prevention and treatment of cardiovascular diseases, the results of research, national and international clinical trials. For publication in the journal are invited both domestic and foreign scientists and clinicians working in the field of cardiology, as well as doctors of other specialties. The magazine covers various issues in cardiology and related specialties. Each issue is prepared by Executive editor of the issue, a respected specialist in the field of epidemiology, prevention and treatment of cardiovascular diseases. The main focus of the publication — scientific articles on original research, the pharmacotherapy of cardiovascular disease, new diagnostic methods. All members of the group of authors should meet all four criteria of authorship set forth in the ICMJE recommendations: 1) concept and design development or data analysis and interpretation, and 2) manuscript justification or verification of critical intellectual content, and 3) final approval for publication of the manuscript, and 4) consent to be responsible for all aspects of the work, and assume that issues relating to the thoroughness and diligent execution of any part of the study submitted are duly investigated and resolved. Great importance the editors attached to the preparation of scientific papers by groups of authors at a high level, literacy, authors, and their ownership information, availability of research results not only to colleagues in Russia, but also abroad.
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