中国肾脏移植受者血脂异常临床诊疗指南(2023版)  

Chinese Clinical Practice Guidelines for Dyslipidemia in Kidney Transplant Recipients(2023 edition)

作　　者：中华医学会器官移植学分会 中国医疗保健国际交流促进会肾脏移植学分会 胡小鹏[2] 薛武军[3] 张子健[2] 丁小明[3] 林俊 李响 Branch of Organ Transplantation,Chinese Medical Association;Branch of Kidney Transplantation,China International Exchange and Promotive Association for Medical and Health Care;Hu Xiaopeng;Xue Wujun(不详;Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020;The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061)

机构地区：[1]不详 [2]首都医科大学附属北京朝阳医院,北京100020 [3]西安交通大学第一附属医院,西安710061 [4]中国人民解放军总医院第八医学中心

出　　处：《中华器官移植杂志》2024年第4期216-232,共17页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82170766, 82370802);北京市自然科学基金(7242056);陕西省卫生健康肾脏移植科研创新平台(2023PT-06)

摘　　要：血脂代谢异常是肾脏移植受者的常见并发症,也是导致动脉粥样硬化性心血管疾病和脑卒中等严重疾病的主要因素。高达60%的肾脏移植受者患有高脂血症,表现为总胆固醇、低密度脂蛋白和/或甘油三酯水平升高。此外,肾脏移植后血脂异常不仅与普遍的风险因素有关,还与使用免疫抑制剂,特别是钙调磷酸酶抑制剂相关,这类药物主要通过改变脂质代谢途径导致血脂异常。因此,制定规范的诊疗流程和提供相应的治疗建议至关重要,其目的是制定肾脏移植受者血脂异常的合理预防、诊断和治疗方案,以提高治疗效果并延长肾脏移植受者及移植肾的存活时间。本指南参考《中国器官移植受者血脂管理指南(2016版)》和2023年版《中国血脂管理指南》,评估了肾脏移植受者的血脂代谢状况并提出分层管理策略。在遵循血脂异常诊疗基本原则的基础上,充分考虑各类免疫抑制剂对血脂代谢的影响及其与降脂药物的相互作用,汇总国内外最新研究成果,制定了《中国肾脏移植受者血脂异常临床诊疗指南》(以下简称"指南")。本指南按照"2009版牛津大学循证医学中心的证据分级与推荐强度标准",对每项临床问题的证据质量和推荐强度进行分级。Abnormal lipid metabolism is a common complication of kidney transplant recipients.And it is a major contributing factor to atherosclerotic cardiovascular disease and stroke.Up to 60%of kidney transplant recipients manifest dyslipidemia as characterized by elevated levels of total cholesterol,low-density lipoprotein and/or triglycerides.Furthermore,dyslipidemia after kidney transplant is linked to not only common risk factors but also dosing of immunosuppressants(e.g.calcineurin inhibitors).These drugs primarily cause dyslipidemia through altering various pathways of lipid metabolism.Therefore it is imperative to formulate standardized diagnostic and therapeutic protocols and offer appropriate management recommendations.The overall goal is to develop effective preventive,diagnostic and therapeutic strategies for dyslipidemia in kidney transplant recipients to improve clinical outcomes and extend the survival of both recipients and transplanted kidneys.This Guideline referred to the stipulations of"Chinese Guidelines for Lipid Management in Organ Transplant Recipients(2016)"and"Chinese Guidelines for Lipid Management(2023)".It assesses the lipid metabolism status of KT recipients and proposes stratified management strategies.By adhering to the basic principles of managing dyslipidemia and considering the effects of various immunosuppressants on lipid metabolism and their interactions with lipid-lowering agents,this Guideline has compiled the latest domestic and international research findings.Also the drafters followed the guidance of"Oxford Centre for Evidence-based Medicine-Levels of Evidence(2009)"to grade the quality of evidence and strength of recommendations for various clinical issues.

关 键 词：肾脏移植 脂代谢 高脂血症 动脉粥样硬化 

分 类 号：R699.2[医药卫生—泌尿科学] R589.2[医药卫生—外科学]