二重滤过血浆置换治疗难治性高脂血症

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。方法 2 0例非家族性高脂血症患者接受二重滤过血浆置换疗法 ,其中 14例患者治疗前血浆总胆固醇 (TC)大于6 .8mmol/L或甘油三脂 (TG)大于 2mmol/L ,低密度脂蛋白 (LDL)水平均高于 3.1mmol/L。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11例患者具有完整的记录 ,其平均年龄 (4 5 .2 5± 8.33) (2 6～ 5 9)岁 ;平均病程为 6 .7年。单次治疗总置换量为 (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± 1.17)mmol/Lvs (3.4 2± 0 .6 3)mmol/L、(3.92± 2 .13)mmol/Lvs (3.5 7± 1.82 )mmol/L、(4 .0 3± 0 .86 )mmol/Lvs (1.13± 0 .6 6 )mmol/L、(1.34± 0 .37)g/Lvs (0 .85± 0 .30 )g/L、(1.34± 0 .5 7)g/Lvs (0 .70± 0 .34)g/L、(176 .14± 75 .5 3)mg/Lvs (98.4 3± 4 4 .0 8)mg/L、(1.0 3± 0 .2 8)mmol/Lvs (0 .6 8±0 .2 2 )mmol/L、(2 6 3.6± 86 .4 9)mg/dlvs (15 4 .88± 4 4 .12 )mg/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。

Objective To investigate the acute effects of single DFPP treatment for non-familial refractory hyperlipidemia. Methods Twenty non-familial refractory hyperlipidemia patients had taken DFPP therapy. Fcurteen of them either had both hypercholesterolemia (totol cholesterol ≥ 6.8mmol/L) and high level of LDL (LDL ≥ 3.1mmol/L) or had both hypertriglyceridemia (triglyceride≥2mmol/l) and high level of LDL. Blood samples were collected from the patients and the serum level of total cholesterol, triglyceride, low density lipoprotein (LDL), Apolipoprotein A (Apo-A), Apolipoprotein B (Apo-B), Lipoprotein(a) (Lp(a)) and fibrinogen were tested just before and after the treatment. Eleven patients had complete recordings. Results The average age of the 11 patients was 45.25±8.33 years old. Total substitute volume was 4183±667 (3000～5000)ml. After treatments there were significant reduction of TC, LDL, Apo(A), Apo(B), Lp(a),HDL and fibrinogen. Those parameters were decreased, 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±86.49)mg/dl to (154.88±44.12)mg/dl (P<0.05, P<0.01) respectively。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 side effect during each therapy. Conclusion DFPP can significantly ameliorate the disorders of lipid metabolism. Patients' serum lipids can be reduced into normal range after single treatment, contributing to reducing the drug dosage and side effects. [