Jansen M, Banyai S, Schmaldienst S, Goldammer A, Rohac M, Hörl W H, Derfler K
Division of Nephrology and Dialysis, University of Vienna, Austria.
Wien Klin Wochenschr. 2000 Jan 28;112(2):61-9.
The DALI (direct adsorption of lipoproteins) LDL-apheresis system is a novel device for the removal of lipoproteins from whole blood.
We report the first long-term treatment experience (16.7 +/- 12.6 months; 57 +/- 43 treatments/patient) using different DALI adsorber sizes (DALI-500, DALI-750, DALI-1000) in seven patients with homozygous (n = 1) and severe heterozygous familial hypercholesterolaemia. For each treatment, 1.6 fold of the calculated blood volume was processed. Treatments were scheduled at weekly or two-weekly intervals.
The smallest DALI-500 configuration was unable to achieve sufficient removal of LDL cholesterol, with the adsorber being exhausted already at desorption of 65% of the calculated blood volume. In contrast, both larger adsorber systems effectively removed lipoproteins until the end of treatment. Therefore, the DALI-750 device was used for long-term treatment. LDL cholesterol (mean pretreatment value: 179 +/- 44 mg/dl) was reduced by 73.4 +/- 7.7% and Lp(a) levels (mean pretreatment value: 43 +/- 33 mg/dl) by 69.5 +/- 8.3%. HDL cholesterol (mean pretreatment value: 47 +/- 15 mg/dl) was reduced by 16.3 +/- 8.0% during the treatment. In the long term, LDL cholesterol was reduced by 54.0 +/- 10.5%--from 259 +/- 101 mg/dl to 119 +/- 19 mg/dl. No serious side effects occurred during the treatment. Long-term evaluation of other laboratory parameters showed a reduction in haemoglobin due to treatment-associated blood loss despite frequent iron supplementation.
Sufficient reductions in LDL cholesterol and Lp(a) were achieved using the DALI-750 system and the treatment was well tolerated. The easy use and short period of 153 +/- 22 minutes required for each treatment are the major advantages of the DALI system as compared to other available LDL-apheresis devices. Potential particle release from the adsorber into the circulation must be ruled out before the system can be introduced in clinical routine.
DALI（脂蛋白直接吸附）低密度脂蛋白分离吸附系统是一种从全血中去除脂蛋白的新型装置。
我们报告了7例纯合子（n = 1）和重度杂合子家族性高胆固醇血症患者使用不同尺寸DALI吸附器（DALI - 500、DALI - 750、DALI - 1000）的首次长期治疗经验（16.7±12.6个月；每位患者57±43次治疗）。每次治疗处理计算血容量的1.6倍。治疗安排为每周或每两周进行一次。
最小的DALI - 500配置无法充分去除低密度脂蛋白胆固醇，在解吸计算血容量的65%时吸附器就已耗尽。相比之下，两种较大的吸附器系统在治疗结束前均能有效去除脂蛋白。因此，DALI - 750装置用于长期治疗。低密度脂蛋白胆固醇（平均治疗前值：179±44mg/dl）降低了73.4±7.7%，脂蛋白(a)水平（平均治疗前值：43±33mg/dl）降低了69.5±8.3%。高密度脂蛋白胆固醇（平均治疗前值：47±15mg/dl）在治疗期间降低了16.3±8.0%。长期来看，低密度脂蛋白胆固醇降低了54.0±10.5%——从259±101mg/dl降至119±19mg/dl。治疗期间未发生严重副作用。对其他实验室参数的长期评估显示，尽管频繁补充铁剂，但由于与治疗相关的失血，血红蛋白有所降低。
使用DALI - 750系统可使低密度脂蛋白胆固醇和脂蛋白(a)充分降低，且治疗耐受性良好。与其他现有的低密度脂蛋白分离吸附装置相比，DALI系统的主要优点是使用简便，每次治疗所需时间短，为153±22分钟。在该系统引入临床常规应用之前，必须排除吸附器向循环系统释放潜在颗粒的可能性。
