Geiss H C, Parhofer K G, Donner M G, Schwandt P
Medical Department II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
Ther Apher. 1999 Aug;3(3):199-202. doi: 10.1046/j.1526-0968.1999.00157.x.
Membrane differential filtration (MDF) is an apheresis technique with which atherogenic lipoproteins can be eliminated from plasma on the basis of particle size. In 52 patients (REMUKAST Study, 1,702 treatments), low density lipoprotein (LDL) cholesterol was decreased by 61%, high density lipoprotein (HDL) cholesterol by 42%, and fibrinogen by 54%. Our own results in 3 patients show decreases of 62%, 31%, and 59%, respectively; lipoprotein (a) (Lp[a]) was reduced by 58%. The elimination of atherogenic lipoproteins was accompanied by a loss of macromolecules (IgM: 55%, IgG: 27%, alpha 2-macroglobulin: 49%) resulting in improved hemorrheologic parameters. Although HDL is eliminated with each apheresis session, pretreatment concentrations of HDL cholesterol increased by 24% during regular apheresis for 1 year (26 patients, REMUKAST Study). However, preapheresis concentrations of other macroglobulins such as immunoglobulins remained decreased compared to concentrations obtained before the first apheresis session (IgM: 34%, IgG: 23%, and IgA: 16%). We conclude that MDF apheresis is an effective method to lower elevated concentrations of atherogenic lipoproteins. The concomitant loss of other macromolecules transiently improves hemorrheology but demands a close monitoring of immunoglobulin concentrations as a safety parameter.
膜滤过分离法（MDF）是一种单采技术，可根据颗粒大小从血浆中清除致动脉粥样硬化脂蛋白。在52例患者中（瑞莫司特研究，1702次治疗），低密度脂蛋白（LDL）胆固醇降低了61%，高密度脂蛋白（HDL）胆固醇降低了42%，纤维蛋白原降低了54%。我们自己对3例患者的研究结果分别显示降低了62%、31%和59%；脂蛋白（a）[Lp（a）]降低了58%。清除致动脉粥样硬化脂蛋白的同时伴随着大分子物质的丢失（IgM：55%，IgG：27%，α2-巨球蛋白：49%），从而改善了血液流变学参数。尽管每次单采都会清除HDL，但在为期1年的定期单采期间（26例患者，瑞莫司特研究），HDL胆固醇的预处理浓度增加了24%。然而，与首次单采前获得的浓度相比，其他大分子球蛋白如免疫球蛋白的单采前浓度仍保持降低（IgM：34%，IgG：23%，IgA：16%）。我们得出结论，MDF单采是降低致动脉粥样硬化脂蛋白升高浓度的有效方法。其他大分子物质的伴随丢失可暂时改善血液流变学，但需要密切监测免疫球蛋白浓度作为安全参数。
