Low density lipoprotein apheresis by membrane differential filtration (cascade filtration).
Low density lipoprotein apheresis by membrane differential filtration (cascade filtration).
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DOI：
10.1046/j.1526-0968.1999.00157.x
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发表时间：
1999-08-01
期刊：
影响因子：
--
通讯作者：
Schwandt, P
中科院分区：
文献类型：
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作者：
Geiss, H C;Parhofer, K G;Schwandt, P
膜差异过滤(MDF)是一种根据颗粒大小从血浆中去除致动脉粥样硬化性脂蛋白的分离技术。在52名患者(REMUKAST研究，1702次治疗)中，低密度脂蛋白(LDL)胆固醇降低了61%，高密度脂蛋白(HDL)胆固醇降低了42%，纤维蛋白原降低了54%。我们自己在3名患者中的结果显示，分别下降了62%、31%和59%；脂蛋白(A)(Lp[a])下降了58%。导致动脉粥样硬化的脂蛋白的消除伴随着大分子(IgM：55%，Ig：27%，α2-巨球蛋白：49%)的丢失，导致血液流变学参数的改善。虽然高密度脂蛋白在每次分离过程中都会被清除，但在一年的常规分离过程中，高密度脂蛋白胆固醇的预处理浓度增加了24%(26例患者，REMUKAST研究)。然而，其他巨球蛋白如免疫球蛋白的分离前浓度仍低于第一次分离前的浓度(免疫球蛋白：34%，免疫球蛋白：23%，免疫球蛋白：16%)。我们认为，MDF采集法是降低升高的致动脉粥样硬化性脂蛋白浓度的有效方法。随之而来的其他大分子的丢失会暂时改善血液流变学，但需要密切监测免疫球蛋白浓度作为安全参数。
Membrane differential filtration (MDF) is an apheresis technique with which atherogenic lipoproteins can be eliminated from plasma on the basis of particle size. In 52 patients (REMUKAST Study, 1,702 treatments), low density lipoprotein (LDL) cholesterol was decreased by 61%, high density lipoprotein (HDL) cholesterol by 42%, and fibrinogen by 54%. Our own results in 3 patients show decreases of 62%, 31%, and 59%, respectively; lipoprotein (a) (Lp[a]) was reduced by 58%. The elimination of atherogenic lipoproteins was accompanied by a loss of macromolecules (IgM: 55%, IgG: 27%, alpha 2-macroglobulin: 49%) resulting in improved hemorrheologic parameters. Although HDL is eliminated with each apheresis session, pretreatment concentrations of HDL cholesterol increased by 24% during regular apheresis for 1 year (26 patients, REMUKAST Study). However, preapheresis concentrations of other macroglobulins such as immunoglobulins remained decreased compared to concentrations obtained before the first apheresis session (IgM: 34%, IgG: 23%, and IgA: 16%). We conclude that MDF apheresis is an effective method to lower elevated concentrations of atherogenic lipoproteins. The concomitant loss of other macromolecules transiently improves hemorrheology but demands a close monitoring of immunoglobulin concentrations as a safety parameter.