二重滤过血浆置换治疗难治性高脂血症的近期和远期疗效

Treatment of Refractory Hyperlipidemia Using Double Filtration Plasmapheresis System(DFPP)

目的 :了解单次二重滤过血浆置换治疗非家族性、难治性高脂血症的短期疗效及对靶器官的长期保护效果。方法 :2 8例非家族性高脂血症患者接受二重滤过血浆置换疗法 ,取治疗前和治疗结束时的血样 ,分别测量血浆TC、TG、LDL、Apo(A)、Apo(B)、Lp(a)、HDL和纤维蛋白原水平。结果 :2 0例患者具有完整的记录 ,平均年龄 5 1.73± 6 .5 8(2 6～ 6 2 )岁 ;平均病程 6 .8年。单次治疗的总置换量为 4 183± 6 6 7(30 0 0～ 5 0 0 0 )ml,治疗前后TC、TG、LDL、Apo(A)、Apo(B)、Lp(a)、HDL和纤维蛋白原水平分别为 6 .86± 1.17mmol/Lvs 3.4 2± 0 .6 3mmol/L、3.92± 2 .13mmol/Lvs 3.5 7± 1.82mmol/L、4 .0 3± 0 .86mmol/Lvs 1.13± 0 .6 6mmol/L、1.34± 0 .37g/Lvs 0 .85± 0 .30g/L、1.34± 0 .5 7g/Lvs 0 .70± 0 .34g/L、176 .14± 75 .5 3mg/Lvs 98.4 3± 4 4 .0 8mg/L、1.0 3± 0 .2 8mmol/Lvs 0 .6 8± 0 .2 2mmol/L、2 6 3.6± 86 .5mg/dlvs 15 4 .9± 4 4 .1mg/dl。TC平均下降 5 1% ;LDL下降约 72 % ;Apo(a)和Apo(b)分别下降 32 %和 4 4 %左右。Lp(a)平均降低 4 0 % ,纤维蛋白原平均下降 4 3%。配对t检验提示单次置换后血浆TC、LDL、Apo(A)、Apo(B)、Lp(a)和纤维蛋白原水平有明显下降 (P <0 .0 5或P

Objective: To investigate the acute effect s of single DFPP treatment for the therapy of non-familial refractory hyperlipidem ia and its long-term effects on organ-protection. Methods: Twent y eight non-familial refractory hyperlipidemia patients had taken DFPP therapy. A blood sample was collected from the patients and the serum level of total chol esterol (TC), triglyceride (TG), low density lipoprotein (LDL), Apolipoprotein A (Apo-A), Apolipoprotein B (Apo-B), Lipoprotein(a) (Lp(a)) and fibrinogen were t ested just before and after the treatment. Twenty patients had completed recordi ngs. Results: The average age of the 20 patients was 51.73±6.58 (26-62)years old. Total substitute volume was 4183±667 (3000～5000)ml. After t reatments there was a significant reduction of TC, LDL, Apo(A), Apo(B), Lp(a),H DL and fibrinogen. Those parameters were decreased respectively, from 6.86±1.17 mmol/L to 3.42±0.63 mmol/L, 3.92±2.13 mmol/L to 3.57±1.82 mmol/L, 4.03± 0.86 mmol/L to 1.13±0.66 mmol/L, 1.34±0.37 g/L to 0.85±0.30 g/L,1.34±0.57 g/ L to 0.70±0.34 g/L, 176.14±75.53 mg/L to 98.43±44.08 mg/L, 1.03±0.28 mmol/L to 0.68±0.22 mmol/L, 263.6± 86.5 mg/dl to 154.9±44.1 mg/dl (P<0.05, P<0.01)。After each treatment the acute reduction in TC, TG, LDL, Apo(A), Apo( B) and fibrinogen was 51%, 72%, 32%, 44%, 40% and 43% respectively. There was no obvious ill effect during each therapy. Eleven patients had followed up for 6 m onths, the serum level of TC, TG and LDL was still lower than that before the DF PP treatment. No episode of cardiocerebrovascular disease was caught during the follow-up. Conclusion:DFPP can significantly ameliorate the diso rders of lipid metabolism. Patients' serum lipids can be reduced into normal ran ge after single treatment, contributing to reduce the drug dosage and side effec ts. DFPP also helps to prevent cardiocerebrovascular diseases and maintain serum lipids in the normal range.