Efficacy of low-density lipoprotein apheresis combined with corticosteroids for cholesterol crystal embolism
Efficacy of low-density lipoprotein apheresis combined with corticosteroids for cholesterol crystal embolism
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DOI：
10.1007/s10157-016-1272-x
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发表时间：
2017-04-01
影响因子：
2.3
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
糖皮质激素已被广泛用于胆固醇结晶栓塞（CCE）患者，低密度脂蛋白单采术（LDL-A）被报道可降低CCE患者终末期肾病的风险。本研究旨在评价LDL-A联合皮质类固醇对CCE患者的肾脏保护作用。回顾性评价了2008年至2013年期间35例血管介入治疗后显示肾脏恶化的CCE患者。所有患者均接受皮质类固醇;其中24例还接受LDL-A治疗，11例未接受，分别指定为LDL-A组和对照组。比较两组患者在诊断为CCE后3个月和1年的eGFR（Delta eGFR）差异。所有患者的基线（血管介入治疗前）肾小球滤过率（eGFR）估计值中位数为38.9 [四分位距（IQR）31.9-49.4] ml/min/1.73 m2。诊断时为14.4（IQR 11.3-21.8）ml/min/1.73 m2。初始皮质类固醇剂量为0.34 +/- 0.10 mg/kg/天。LDL-A组的平均LDL-A治疗次数为4.3 +/- 1.8。LDL-A治疗后eGFR显著增加，从15.0（IQR 12.3-20.1）增加到19.6（IQR 14.3-23.6）ml/min/1.73 m2（P < 0.05）。3个月时LDL-A组的Δ eGFR倾向于高于对照组[中位数6.5（IQR 5.1-9.3）与2.6（IQR -0.6至6.3）ml/min/1.73 m（2），P = 0.095]，1年时显著更高[中位数7.5（IQR 5.4-8.7）与2.2（IQR -3.8至5.1）ml/min/1.73 m（2），P = 0.019]。对于CCE患者，LDL-A联合皮质类固醇比单独使用皮质类固醇更能恢复恶化的肾功能。
Corticosteroids have been widely used in patients with cholesterol crystal embolism (CCE) and low-density lipoprotein apheresis (LDL-A) was reported to reduce the risk of end-stage renal disease in patients with CCE. This study was designed to evaluate the renoprotective effects of LDL-A in combination with corticosteroids in patients with CCE.Thirty-five patients with CCE who, between 2008 and 2013, had shown renal deterioration after vascular interventions were retrospectively evaluated. All patients received corticosteroids; of these, 24 also received LDL-A and 11 did not, designated LDL-A and control groups, respectively. Differences in eGFR (Delta eGFR), 3 months and 1 year after CCE diagnosis, were compared in the two groups.The median estimated glomerular filtration rate (eGFR) in all patients was 38.9 [interquartile range (IQR) 31.9-49.4] ml/min/1.73 m(2) at baseline (before vascular intervention). At diagnosis, it was 14.4 (IQR 11.3-21.8) ml/min/1.73 m(2). The initial corticosteroid dose was 0.34 +/- 0.10 mg/kg/day. The mean number of LDL-A treatment sessions in the LDL-A group was 4.3 +/- 1.8. eGFR was increased significantly after LDL-A treatments, from 15.0 (IQR 12.3-20.1) to 19.6 (IQR 14.3-23.6) ml/min/1.73 m(2) (P < 0.05). Delta eGFR tended to be higher in the LDL-A than in the control group at 3 months [median 6.5 (IQR 5.1-9.3) vs. 2.6 (IQR -0.6 to 6.3) ml/min/1.73 m(2), P = 0.095] and was significantly higher at 1 year [median 7.5 (IQR 5.4-8.7) vs. 2.2 (IQR -3.8 to 5.1) ml/min/1.73 m(2), P = 0.019].LDL-A plus corticosteroids may restore deteriorated renal function better than corticosteroids alone in patients with CCE.