Matsuzaki Masunori, Hiramori Katsuhiko, Imaizumi Tsutomu, Kitabatake Akira, Hishida Hitoshi, Nomura Masanori, Fujii Takashi, Sakuma Ichiro, Fukami Kenichi, Honda Takashi, Ogawa Hiroshi, Yamagishi Masakazu
Division of Cardiovascular Medicine, Department of Medical Bioregulation, Yamaguchi University School of Medicine, 1-1-1 Minamikogoshi, Ube, Yamaguchi 755-8505, Japan.
J Am Coll Cardiol. 2002 Jul 17;40(2):220-7. doi: 10.1016/s0735-1097(02)01955-1.
We sought to assess the effects of low density lipoprotein (LDL)-apheresis (LDL-A) for regression of coronary plaque in familial hypercholesterolemia (FH), we set up a one-year follow-up multicenter trial using coronary angiography and intravascular ultrasound (IVUS).
It is still unclear whether aggressive lipid-lowering therapy by LDL-A leads to the regression of coronary plaque in patients with FH.
Eighteen patients with FH were assigned to one of two groups: medication + LDL-A (LDL-A group, n = 11) and medication only (medication group, n = 7). Total cholesterol, triglycerides, high density lipoprotein cholesterol and LDL cholesterol were measured in all subjects at the outset of treatment (baseline) and every three months thereafter. Coronary angiography and IVUS were performed at the outset and after the one-year follow-up period to measure minimal lumen diameter (MLD) by coronary angiogram and plaque area (PA) by IVUS.
The LDL-A group showed 28.4% reduction in total cholesterol (from 275 +/- 27 mg/dl to 197 +/- 19 mg/dl) and 34.3% reduction in LDL cholesterol (from 213 +/- 25 mg/dl to 140 +/- 27 mg/dl) after one-year follow-up, while the medication group showed no changes in cholesterol levels. There were significant interactions between both treatments in total cholesterol (p = 0.0001), LDL cholesterol (p = 0.0001), MLD (p = 0.008) and PA (p = 0.017) using two-way repeated-measures analysis of variance by the SAS system (SAS Institute Inc., Cary, North Carolina). Significant differences were seen in net change in MLD (p = 0.004) and PA (p = 0.008) during the one-year follow-up period between both groups.
These results suggest that aggressive lipid-lowering therapy using the combination of LDL-A and lipid-lowering drugs may induce regression of coronary atherosclerotic plaque in FH patients.
我们试图评估低密度脂蛋白（LDL）- 血液成分分离术（LDL-A）对家族性高胆固醇血症（FH）患者冠状动脉斑块消退的影响，我们使用冠状动脉造影和血管内超声（IVUS）开展了一项为期一年的多中心随访试验。
LDL-A强化降脂治疗是否能使FH患者的冠状动脉斑块消退仍不清楚。
18例FH患者被分为两组之一：药物治疗 + LDL-A（LDL-A组，n = 11）和单纯药物治疗（药物治疗组，n = 7）。在治疗开始时（基线）及此后每三个月对所有受试者测量总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。在开始时及一年随访期后进行冠状动脉造影和IVUS，通过冠状动脉造影测量最小管腔直径（MLD），通过IVUS测量斑块面积（PA）。
随访一年后，LDL-A组总胆固醇降低了28.4%（从275±27mg/dl降至197±19mg/dl），低密度脂蛋白胆固醇降低了34.3%（从213±25mg/dl降至140±27mg/dl），而药物治疗组胆固醇水平无变化。使用SAS系统（SAS Institute Inc.，北卡罗来纳州卡里）进行的双向重复测量方差分析显示，两种治疗在总胆固醇（p = 0.0001）、低密度脂蛋白胆固醇（p = 0.0001）、MLD（p = 0.008）和PA（p = 0.017）方面存在显著交互作用。两组在一年随访期内MLD（p = 0.004）和PA（p = 0.008）的净变化存在显著差异。
这些结果表明，联合使用LDL-A和降脂药物的强化降脂治疗可能会使FH患者的冠状动脉粥样硬化斑块消退。
