Krebs A, Krebs K, Keller F
Division of Nephrology, Medical Faculty, University of Ulm, Germany.
Int J Artif Organs. 2004 Feb;27(2):137-48. doi: 10.1177/039139880402700209.
To compare long-term efficacy and biocompatibility of the 5 most commonly applied LDL-apheresis techniques using a specifically modified calculation method of the area under the curve (AUC) for laboratory parameters.
Retrospective long-term analysis of 20 patients with homozygous or severe heterozygous familial hypercholesterolemia.
The following 5 extra-corporeal LDL-apheresis methods were compared: IMAL (Immuno Adsorption of Lipoproteins), DSA (Dextran Sulphate Adsorption), HELP (Heparin Induced Extra-corporeal LDL Precipitation), DALI (Direct Adsorption of Lipoproteins), MDF (Membrane Differential Filtration).
AUC derived plasma concentrations (C(AUC)) of lipoproteins between two apheresis procedures and their long-term course. Comparison of biocompatibility and efficacy concerning the LDL-C target of < 2.6 mmol/L of 5 apheresis techniques. Progression of atherosclerosis in patients with severe hypercholesterolemia.
The means of AUC derived average plasma concentrations (C(AUC)) of all treatment intervals were for LDL-C and the LDL/HDL ratio as follows: IMAL (5.59 mmol/L; ratio 4.1), DSA (3.03 mmol/L; ratio 2.0), HELP (4.06 mmol/L; ratio 2.2), DALI (3.83 mmol/L; ratio 3.3), MDF (3.26 mmol/L; ratio 3.2). Coronary heart disease and cardiac events (myocardial infarction, PTCA/ stent implantation, CABG) progressed in only 2 patients whereas atherosclerosis manifestations (sclerosis abdominal aorta, carotid artery stenosis, peripheral vascular disease) worsened in 13 patients. Mean ergometric capacity improved from 112 to 118 Watt.
All 5 apheresis methods (IMAL, DSA, HELP, DALI, MDF) proved to be safe and suitable for long-term treatment in patients with severe hypercholesterolemia. The introduction of the C(AUC) revealed that the target of LDL-C < 2.6 mmol/L was not achieved with regard to the time averaged concentration (C(AUC)).
使用一种针对实验室参数的曲线下面积（AUC）的特殊修正计算方法，比较5种最常用的低密度脂蛋白去除术（LDL-apheresis）技术的长期疗效和生物相容性。
对20例纯合子或重度杂合子家族性高胆固醇血症患者进行回顾性长期分析。
比较以下5种体外LDL去除术方法：IMAL（脂蛋白免疫吸附）、DSA（硫酸葡聚糖吸附）、HELP（肝素诱导的体外LDL沉淀）、DALI（脂蛋白直接吸附）、MDF（膜差分过滤）。
两次去除术之间脂蛋白的AUC衍生血浆浓度（C(AUC)）及其长期变化过程。比较5种去除术技术在LDL-C目标值<2.6 mmol/L方面的生物相容性和疗效。重度高胆固醇血症患者动脉粥样硬化的进展情况。
所有治疗间隔的AUC衍生平均血浆浓度（C(AUC)）的均值，对于LDL-C和LDL/HDL比值如下：IMAL（5.59 mmol/L；比值4.1）、DSA（3.03 mmol/L；比值2.0）、HELP（4.06 mmol/L；比值2.2）、DALI（3.83 mmol/L；比值3.3）、MDF（3.26 mmol/L；比值3.2）。仅2例患者发生冠心病和心脏事件（心肌梗死、经皮冠状动脉腔内血管成形术/支架植入术、冠状动脉旁路移植术），而13例患者的动脉粥样硬化表现（腹主动脉硬化、颈动脉狭窄、外周血管疾病）恶化。平均运动能力从112瓦提高到118瓦。
所有5种去除术方法（IMAL、DSA、HELP、DALI、MDF）均被证明对重度高胆固醇血症患者长期治疗是安全且合适的。C(AUC)的引入表明，就时间平均浓度（C(AUC)）而言，未达到LDL-C<2.6 mmol/L的目标。
