中国血液净化

›› 2003, Vol. 2 ›› Issue (8): 424-426.

• 论著 • 上一篇    下一篇

二重滤过血浆置换治疗难治性高脂血症

方 艺 丁小强 陈利明 　滕 杰 钟一红 傅辰生 邹建洲   

  1. 200032 上海，复旦大学附属中山医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-08-19 发布日期:2003-08-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-08-19 Published:2003-08-19

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摘要： 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 20 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(45.25±8.33) (26～59)岁；平均病程为6.7年。单次治疗总置换量为(4183±667) (3000～5000)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/L vs (3.42±0.63)mmol/L、(3.92±2.13)mmol/L vs (3.57±1.82)mmol/L、(4.03±0.86)mmol/L vs (1.13±0.66)mmol/L、(1.34±0.37)g/L vs (0.85±0.30)g/L、(1.34±0.57)g/L vs (0.70±0.34)g/L、(176.14±75.53)mg/L vs (98.43±44.08)mg/L、(1.03±0.28)mmol/L vs (0.68±0.22)mmol/L、(263.6±86.49)mg/dl vs (154.88±44.12)mg/dl。TC平均下降51%；LDL下降约72%；Apo(a)和Apo(b)分别下降32%和44%左右。Lp(a)亦能降低40%左右，纤维蛋白原约下降43%。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<0.05或P<0.01）。治疗过程中未发生低血压、过敏等副反应。结论 二重滤过血浆置换是治疗高脂血症有效、安全的方法。对经最大剂量降脂药物和饮食控制后仍难以纠正的高脂血症或不能耐受降脂药物的病例，二重滤过能显著改善脂质代谢异常。单次治疗后血脂可立即降至正常，有利于减少药物的剂量和副作用。

关键词: 二重滤过血浆置换, 高脂血症, 低密度脂蛋白, 脂蛋白a, 纤维蛋白原

Abstract:

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 ≥ 2 mmol/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.

Key words: Hyperlipidemia, Low density lipoprotein(LDL), Lipoprotein (a), Fibrinogen