Balletshofer Bernd M, Stock Jan, Rittig Kilian, Lehn-Stefan Angela, Braun Norbert, Burkart Frank, Plontke Stefan, Klingel Reinhard, Häring Hans-Ulrich
Department of Endocrinology, Metabolism and Vascular Medicine, Eberhard-Karls-University, Tübingen, Germany.
Ther Apher Dial. 2005 Oct;9(5):385-90. doi: 10.1111/j.1744-9987.2005.00316.x.
Single low density lipoprotein (LDL) fibrinogen apheresis has shown beneficial effects in the treatment of patients with sudden sensorineural hearing loss (SSHL). Pathophysiologically, a microcirculatory disorder of the inner ear, probably caused by disturbed endothelial function, is discussed as a final common pathway of a variety of SSHL etiologies. Thus, we carried out a prospective pilot study on the efficacy of Rheopheresis on vascular function in these patients, embedded into an ongoing randomized controlled multicenter trial investigating the efficacy of Rheopheresis for the treatment of SSHL. Potential modulation of systemic endothelial dysfunction by Rheopheresis was examined by measuring flow-associated vasodilatation of the brachial artery (according to the criteria of the American College of Cardiology) in a small group of patients suffering from SSHL (N=6, 5m/1f, mean age 56+/-11 years) within the last 3 days. At baseline, five of the six patients with acute hearing loss showed endothelial dysfunction as evidenced by diminished flow-mediated vasodilatation (FMD<5%). After a single Rheopheresis treatment, flow-mediated vasodilatation improved significantly (from 3.9+/-3.6% to 7.2+/-2.4%, P=0.05, mean+/-SD, two-sided paired T-test). This was paralleled by a reduction in fibrinogen (364+/-216 mg/dL to 142+/-96 mg/dL, P=0.03), total cholesterol (228+/-23 to 98+/-10, P<0.0001) and LDL cholesterol levels (153+/-8 mg/dL to 83+/-23 mg/dL, P<0.01). Based on this case series we conclude that single Rheopheresis treatment might have an acute beneficial effect on endothelial dysfunction in patients suffering from SSHL.
单次低密度脂蛋白（LDL）纤维蛋白原吸附疗法已显示出对突发性感音神经性听力损失（SSHL）患者的治疗具有有益效果。从病理生理学角度来看，内耳的微循环障碍，可能是由内皮功能紊乱引起的，被认为是多种SSHL病因的最终共同途径。因此，我们在一项正在进行的随机对照多中心试验中，对这些患者进行了一项关于血液成分单采对血管功能疗效的前瞻性试点研究，该试验旨在研究血液成分单采治疗SSHL的疗效。通过测量一小群在过去3天内患有SSHL的患者（N = 6，5名男性/1名女性，平均年龄56±11岁）肱动脉的血流相关血管舒张情况（根据美国心脏病学会的标准），来检查血液成分单采对全身内皮功能障碍的潜在调节作用。在基线时，6名急性听力损失患者中有5名表现出内皮功能障碍，这可通过血流介导的血管舒张减弱来证明（血流介导的血管舒张<5%）。经过单次血液成分单采治疗后，血流介导的血管舒张显著改善（从3.9±3.6%提高到7.2±2.4%，P = 0.05，平均值±标准差，双侧配对T检验）。同时，纤维蛋白原（从364±216 mg/dL降至142±96 mg/dL，P = 0.03）、总胆固醇（从228±23降至98±10，P<0.0001）和低密度脂蛋白胆固醇水平（从153±8 mg/dL降至83±23 mg/dL，P<0.01）均有所降低。基于这个病例系列，我们得出结论，单次血液成分单采治疗可能对患有SSHL的患者的内皮功能障碍具有急性有益作用。
