Wendler T, Schilling R, Lennertz A, Sodemann K, Kleophas W, Messner H, Riechers G, Wagner J, Keller C, Bosch T
Department I of Internal Medicine, Nephrology Division, University Hospital, Munich-Grosshadern, Munich, Germany.
J Clin Apher. 2003;18(4):157-66. doi: 10.1002/jca.10071.
Direct adsorption of lipids (DALI) is the first LDL-apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60-80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL-C 162 +/- 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QB was held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre-existing av-fistulas. The anticoagulation was performed by a heparin bolus plus ACD-A at a ratio of citrate:blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL-C reductions (derived from LDL-C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB=60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL-C losses were < or =10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb=60/120/240 ml/min. On average, DALI LDL-apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (-42%).
脂质直接吸附法（DALI）是第一种与全血兼容的低密度脂蛋白去除术方法。通常，血流速度调整为60 - 80毫升/分钟，这导致每次治疗时间约为2小时。本研究旨在测试在高血流速度下通过DALI去除低密度脂蛋白胆固醇（LDL-C）和脂蛋白（a）[Lp(a)]的安全性和有效性，以缩短治疗时间。七个中心的13名患有高胆固醇血症（基线时LDL-C为162±42毫克/分升）和冠状动脉疾病的慢性DALI患者接受了每周或每两周一次的DALI血液成分单采治疗。血流速度QB分别在至少两个疗程中保持恒定，并从60增加到80、120、160、200和240毫升/分钟。所有患者均有预先存在的动静脉内瘘。抗凝采用肝素推注加ACD-A，枸橼酸盐与血液的比例为1:20至1:90。临床上，各疗程耐受性良好，仅26/201次（12%）治疗出现轻微不良事件。对于QB = 60/80/120/160/200/240毫升/分钟，急性LDL-C降低（源自脂蛋白电泳测定的LDL-C水平）平均为72/66/60/53/50/48%。Lp(a)降低分别为68/67/62/60/58/56%，而高密度脂蛋白胆固醇（HDL-C）损失≤10%。常规血液化学检查和血细胞计数保持在正常范围内。在QB = 60/120/240毫升/分钟时，治疗时间平均为142/83/45分钟。平均而言，对于血液通路良好的患者，DALI低密度脂蛋白去除术在高达至少120毫升/分钟的高血流速度下可以安全有效地进行，这显著缩短了治疗时间，从142分钟降至83分钟（-42%）。
