Low-density lipoprotein apheresis: An overview
Low-density lipoprotein apheresis: An overview
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DOI：
10.1046/j.1526-0968.2003.00070.x
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发表时间：
2003-08-01
影响因子：
1.9
通讯作者：
Latza, R
中科院分区：
文献类型：
--
作者：
Bambauer, R;Schiel, R;Latza, R
动脉粥样硬化合并心肌梗死、中风和外周细胞疾病在工业化国家的发病率和死亡率统计中仍居首位。公认的危险因素有吸烟、高血压、糖尿病和中心性肥胖。此外，高脂血症与动脉粥样硬化之间有很强的相关性。严重高脂血症患者，有时合并脂蛋白(a) （Lp(a)）水平升高，冠心病（CHD）对饮食和降脂药物难治性，预后较差。对于此类患者，常规低密度脂蛋白（LDL）分离治疗是治疗选择。目前，有四种不同的LDL分离系统可用：免疫吸附、肝素诱导的体外LDL/纤维蛋白原沉淀、葡聚糖硫酸盐LDL吸附和LDL血液灌流。对于所使用的不同LDL分离系统，在临床结果或总胆固醇、LDL、高密度脂蛋白（HDL）或甘油三酯浓度方面没有显著差异。然而，对于升高的Lp(a)水平，免疫吸附法似乎是最有效的。45例家族性高胆固醇血症患者（25名女性，20名男性）对饮食和降脂药物有抵抗，低密度脂蛋白（LDL）采珠术进行了95.6+/-44.7个月。使用了四种不同的系统（Liposorber, 32 / 45，日本大阪的Kaneka； Therasorb, 6 / 45，德国慕尼黑的Baxter； Lipopak, 2 / 45，俄罗斯莫斯科的Pocard； Dali, 5 / 45，德国St. Wendel的Fresenius）。通过所有方法，总胆固醇平均降低57%，低密度脂蛋白平均降低55.9%，脂蛋白(a)平均降低75.8% (Lp[a])，甘油三酯平均降低45.9%，HDL平均增加14.3%。所有方法的严重副作用如休克或过敏反应非常罕见（0.3%）。在治疗过程中，45名患者中有44名患者的总体幸福感和表现有所改善。目前的数据表明，LDL分离治疗对最大保守治疗抵抗的家族性高胆固醇血症患者是非常有效和安全的，即使是长期应用。
Atherosclerosis with myocardial infarction, stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial hypertension, diabetes mellitus, and central obesity. Furthermore, there is a strong correlation between hyperlipidemia and atherosclerosis. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lp(a)) levels, and coronary heart disease (CHD) refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are four different LDL apheresis systems available: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL adsorption and LDL hemoperfusion. Regarding the different LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein (HDL), or triglyceride concentrations. With respect to elevated Lp(a) levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low-density lipoprotein (LDL) apheresis was performed over 95.6+/-44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total cholesterol, 55.9% for LDL, 75.8% for lipoprotein (a) (Lp[a]), and 45.9% for triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as shock or allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. The present data demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe even in long-term application.