低密度脂蛋白去除术及维生素E修饰膜对动脉硬化闭塞症血液透析患者颈动脉粥样硬化的影响

Effects of LDL apheresis and vitamin E-modified membrane on carotid atherosclerosis in hemodialyzed patients with arteriosclerosis obliterans.

作者信息

Nakamura Tsukasa, Kawagoe Yasuhiro, Matsuda Takaharu, Takahashi Yutaka, Sekizuka Keiko, Ebihara Isao, Koide Hikaru

机构信息

Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.

出版信息

Kidney Blood Press Res. 2003;26(3):185-91. doi: 10.1159/000071884.

DOI:10.1159/000071884

PMID:12886046

Abstract

BACKGROUND

Hemodialysis patients manifest accelerated atherosclerosis. Hemodialysis is associated with oxidative stress, which can be partially prevented with the use of a vitamin E-coated dialyzer. Adsorption of low-density lipoprotein (LDL) has been applied in the treatment of arteriosclerosis obliterans (ASO). The aim of the present study was to determine whether the vitamin E-coated dialyzer and/or LDL apheresis affects carotid atherosclerosis in hemodialysis patients with ASO.

METHODS

Thirty hemodialysis patients with ASO were divided into four treatment groups: treatment with conventional cellulose or synthetic membranes (group A, n = 12), treatment with vitamin E-coated membrane (group B, n = 7), treatment with conventional membrane and LDL apheresis (group C, n = 6), and treatment with vitamin E-coated membrane and LDL apheresis (group D, n = 5). Carotid artery intima-media thickness (IMT) and arterial stiffness assessed by pulse wave velocity (PWV), plasma C-reactive protein (CRP) and interleukin (IL)-6 were measured before and 10 weeks after treatment and compared between groups. All values were referred to measurements after LDL apheresis.

RESULTS

IMT and PWV, plasma CRP and IL-6 showed little change in group A throughout the experimental period. These decreased slightly from the baseline value in group B, but the change was not significant. In group C, IMT decreased from 1.12 +/- 0.24 to 1.02 +/- 0.18 mm (p < 0.05), and PWV decreased from 2,266 +/- 380 to 1,968 +/- 342 cm/s (p < 0.05). Plasma CRP and IL-6 concentrations also decreased significantly compared with baseline (p < 0.05). In group D, IMT decreased from 1.18 +/- 0.26 to 0.92 +/- 0.18 mm (p < 0.01), and PWV decreased from 2,284 +/- 390 to 1,786 +/- 284 cm/s (p < 0.01). Plasma CRP and IL-6 levels also decreased significantly compared with baseline (p < 0.01).

CONCLUSION

These data suggest that LDL apheresis and the vitamin E-coated membrane dialysis in combination may prevent further progression of atherosclerosis in hemodialysis patients with ASO.

摘要

背景

血液透析患者表现出动脉粥样硬化加速。血液透析与氧化应激相关，使用维生素E涂层透析器可部分预防氧化应激。低密度脂蛋白（LDL）吸附已应用于闭塞性动脉硬化症（ASO）的治疗。本研究的目的是确定维生素E涂层透析器和/或LDL单采是否会影响患有ASO的血液透析患者的颈动脉粥样硬化。

方法

30例患有ASO的血液透析患者被分为四个治疗组：使用传统纤维素或合成膜进行治疗（A组，n = 12），使用维生素E涂层膜进行治疗（B组，n = 7），使用传统膜和LDL单采进行治疗（C组，n = 6），以及使用维生素E涂层膜和LDL单采进行治疗（D组，n = 5）。在治疗前和治疗10周后测量颈动脉内膜中层厚度（IMT）以及通过脉搏波速度（PWV）评估的动脉僵硬度、血浆C反应蛋白（CRP）和白细胞介素（IL）-6，并在组间进行比较。所有数值均参考LDL单采后的测量值。

结果

在整个实验期间，A组的IMT、PWV、血浆CRP和IL-6几乎没有变化。B组这些指标较基线值略有下降，但变化不显著。在C组中，IMT从1.12±0.24降至1.02±0.18毫米（p<0.05），PWV从2266±380降至1968±342厘米/秒（p<0.05）。与基线相比，血浆CRP和IL-6浓度也显著下降（p<0.05）。在D组中，IMT从1.18±0.26降至0.92±0.18毫米（p<0.01），PWV从2284±390降至1786±284厘米/秒（p<0.01）。与基线相比，血浆CRP和IL-6水平也显著下降（p<0.01）。