低密度脂蛋白分离技术

Low-density Lipoprotein Apheresis.

目前 ,普遍认为人类血液中低密度脂蛋白 (low densitylipoprotein ,LDL)水平的升高及其氧化是导致动脉粥样硬化发生、发展最重要的一个危险因素。为此开发出了许多技术和药物来降低血LDL的水平 ,其中 ,通过体外循环直接从血浆或全血中除去LDL的LDL分离技术被认为是最有效和最有前途的治疗方法 ,特别是对一些药物治疗和饮食控制无效的家族性高胆固醇的病人更显得有意义。最近的研究表明 ,LDL分离技术不仅能有效地降低血浆中的LDL水平 ,而且还能减少LDL的氧化及降低LDL氧化的易感性。现今已有 7种类型的LDL分离技术应用于临床 ,即血浆交换、常规双重滤过、加热双重滤过、硫酸右旋糖酐纤维素吸附、免疫吸附、肝素沉淀及LDL的血液灌流分离技术。这几种技术各有其优缺点。总的说来 ,血浆交换、常规双重滤过及加热双重滤过的选择性较差 ,但操作简便、价格较为便宜 ;硫酸右旋糖酐纤维素吸附、免疫吸附、肝素沉淀的选择性较高 ,但操作复杂、价格昂贵 ;LDL的血液灌流分离技术不同于前述几种技术 ,它能直接从全血中特异性地吸附LDL ,但其应用于临床的时间短 ,还需积累应用经验。

The elevation and oxidation of low density lipoprotein (LDL) in human blood are widely recognized as one of the most important risk factors for developing atherosclerosis. Many techniques have been used to reduce LDL levels in human blood. Among them, LDL apheresis, direct removal of LDL from plasma or blood by using an extracorporeal circulation technique, is thought to be the most promising and efficient treatment, especially for those patients with familial hypercholesterolemia who do not respond to diet or lipid lowering drugs. Recent investigation revealed that LDL apheresis not only sufficiently lower the levels of LDL in the plasma, but also decrease susceptibility of LDL to oxidation and reduce the levels of oxidized LDL. Currently, seven types of LDL apheresis technologies are available. They are plasmapheresis, double filtration plasmapheresis, thermofiltration, chemical LDL adsorption onto dextran sulfate, immunoadsorption using Anti LDL Antibodies, heparin mediated extracoporeal low density lipoprotein fibrinogen precipitation (HELP SYSTEM) and LDL hemoperfusion. Each of these techniques has its advantages and disadvantages. In this article, all these lipid apheresis procedures are reviewed.