Low-Density Lipoprotein Apheresis Ameliorates Renal Prognosis of Cholesterol Crystal Embolism
Low-Density Lipoprotein Apheresis Ameliorates Renal Prognosis of Cholesterol Crystal Embolism
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DOI：
10.1111/1744-9987.12345
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发表时间：
2015-08-01
影响因子：
1.9
通讯作者：
Taguma, Yoshio
中科院分区：
文献类型：
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作者：
Ishiyama, Katsuya;Sato, Toshinobu;Taguma, Yoshio
皮质类固醇和他汀类药物等药物已用于治疗胆固醇晶体栓塞（CCE），但预后仍然较差。本研究评估了低密度脂蛋白单采术 (LDL-A) 对 CCE 患者的疗效。对血管介入治疗后出现肾功能恶化的 CCE 患者进行回顾性研究。收集了有关人口统计变量、临床测量和药物使用的信息。结果是 24 周时维持性透析的发生率和死亡率。共纳入49例CCE患者，其中37例（76%）经病理诊断，其余经临床诊断。基线和诊断时的中位估计 GFR 分别为每 1.73 m(2) 40.5 和 13.4 mL/min。 42 名患者（86%）使用皮质类固醇，30 名患者（61%）使用他汀类药物，29 名患者（59%）使用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂。 25 名患者（LDL-A 组）进行了 LDL-A 检测，24 名患者（对照组）未进行 LDL-A 检测。与对照组相比，LDL-A 组的吸烟率（100% vs. 72%，P = 0.02）、白细胞计数（8900/mm(3) vs. 7000/mm(3)）和皮质类固醇使用（96% vs. 75%）较高，但各组之间的其他人口统计学和临床参数没有差异。 LDL-A组患者的维持性透析发生率较低（2/25 (8%) vs. 8/24 (33%)，P < 0.05），且死亡率呈较低趋势（2/25 (8%) vs. 7/24 (29%)，P = 0.074）。这些结果表明，LDL-A 可降低严重肾 CCE 患者血管介入治疗后维持透析的风险。
Drugs such as corticosteroids and statins have been used to treat cholesterol crystal embolism (CCE), but the prognosis remains poor. This study evaluated the efficacy of low-density lipoprotein apheresis (LDL-A) in patients with CCE. Patients with CCE who showed renal deterioration after vascular interventions were studied retrospectively. Information on demographic variables, clinical measurements, and medication use was collected. The outcomes were incidence of maintenance dialysis and mortality at 24 weeks. A total of 49 patients with CCE were included, among whom 37 (76%) were diagnosed pathologically and the remainder were diagnosed clinically. The median estimated GFR at baseline and at diagnosis were 40.5 and 13.4 mL/min per 1.73 m(2), respectively. Corticosteroids were used in 42 patients (86%), statins in 30 patients (61%), and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in 29 patients (59%). LDL-A was performed in 25 patients (LDL-A group), and not in 24 patients (control group). Smoking (100% vs. 72%, P = 0.02), white blood cell count (8900/mm(3) vs. 7000/mm(3)) and corticosteroid use (96% vs. 75%) were higher in the LDL-A group compared with the control group, but there were no differences in other demographic and clinical parameters between the groups. Patients in the LDL-A group had a lower incidence of maintenance dialysis (2/25 (8%) vs. 8/24 (33%), P < 0.05), and a trend towards lower mortality (2/25 (8%) vs. 7/24 (29%), P = 0.074). These results suggest that LDL-A decreases the risk of maintenance dialysis in severe renal CCE patients after vascular interventions.