TREATMENT OF FAMILIAL HYPERCHOLESTEROL. BY DEXTRAN SULFATE ADSORPTION/APHERESIS

硫酸葡聚糖选择性去除低密度脂蛋白的研究 亲和吸附在家族性 高胆固醇血症（FH）。纯合子和杂合子患者 只要他们的血浆LDL-胆固醇水平 浓度超过180毫克/分升，尽管最大药物和饮食 管理原型硫酸葡聚糖单采系统（Liposorber LA-15，Kanegafuchi，日本）去除LDL而不影响HCL胆固醇，或 白蛋白浓度，从而允许自体LDL耗尽的 血浆和避免需要含白蛋白的替代溶液。 每两周处理一个半血浆体积。两 纯合子患者完成了18周的研究。在这两 个体，该程序使总胆固醇降低75 低密度脂蛋白胆固醇水平降低86%。平均术前 LDL-胆固醇水平为237 ± 31 mg/dl，术后 数值为34 ± 4 mg/dl（n = 30）。Lp（a）水平下降82% (47加/减27至8加/减4 mg/dl）。HCL-胆固醇和白蛋白 浓度不受程序的显著影响。 时间平均LDL-胆固醇浓度<160 mg/dl， 将连续LDL单采程序之间的间隔保持在两个 周手术耐受性良好，无明显不良反应。 反应发生了。 我们的数据表明，硫酸葡聚糖吸附是一种安全有效的 选择性清除血浆中LDL-胆固醇的方法，具有优点， 与简单的血浆置换相比， 胶体替代溶液和促进更有益的LDL-HCL 胆固醇比率

Selective removal of low density lipoprotein (LDL) by dextran sulfate affinity adsorption was evaluated in patients with familial hypercholesterolemia (FH). Patients with both homozygous and heterozygous disease were eligible for treatment as long as their plasma LDL-cholesterol concentrations exceeded 180 mg/dl despite maximal drug and dietary management. The prototype dextran sulfate apheresis system (Liposorber LA-15, Kanegafuchi, Japan) removed LDL without affecting HCL cholesterol or albumin concentrations, thus allowing return of autologous LDL-depleted plasma and avoiding the need for albumin-containing replacement solutions. One and one-half plasma volumes were processed every two weeks. Two homozygous patients completed an 18-week period of study. In these two individuals, the procedures effected a 75% reduction in total cholesterol and an 86% reduction in LDL cholesterol levels. Mean pre-procedure LDL-cholesterol levels were 237 plus/minus 31 mg/dl and post-procedure values were 34 plus/minus 4 mg/dl (n = 30). Lp(a) levels declined by 82% (47 plus/minus 27 to 8 plus/minus 4 mg/dl). HCL-cholesterol and albumin concentrations were not significantly affected by the procedures. Time-averaged LDL-cholesterol concentrations of <160 mg/dl were attained by keeping the interval between successive LDL-apheresis procedures at two weeks. The procedures were very well tolerated and no significant adverse reactions occurred. Our data suggest that dextran sulfate adsorption is a safe and effective way to selectively clear plasma of LDL-cholesterol, and has advantages, when compared to simple plasma exchange, of eliminating the need for colloid replacement solutions and promoting a more beneficial LDL-HCL cholesterol ratio.