Thiery J
Institut für Klinische Chemie, Ludwig-Maximilians-Universität, München.
Arzneimittelforschung. 1990 Mar;40(3A):383-8.
A therapeutic strategy is presented which combines the use of HMG-CoA (3-hydroxy-3-methylglutaryl-CoA) reductase inhibitors with extracorporeal HELP-apheresis for the simultaneous elimination of LDL and plasma fibrinogen to ideal plasma concentrations. With HELP-treatment alone LDL (low density lipoprotein)-cholesterol and fibrinogen could be reduced to approx. 50-60% of original plasma levels; medication with HMG-CoA reductase inhibitors alone caused a LDL-cholesterol decrease by a mean of 40% from the untreated values. A combination of both methods led to a reduction in the LDL-cholesterol values of 70-80%. The high efficacy and safety of this combined treatment in patients with coronary artery disease (CAD) offers the possibility to normalize even markedly severe heterozygous hypercholesterolemia with plasma-LDL concentrations of about 450 mg/dl to ideal LDL-levels of below 120 mg/dl. This therapeutic strategy may be useful in the secondary prevention of CAD in patients with and without familial hypercholesterolemia if plasma cholesterol cannot be reduced by diet and drug treatment to a sufficient extent. Presumably one to two years of treatment will be required to retard the CAD and could initiate a regression of coronary sclerosis.
本文提出了一种治疗策略，即将HMG-CoA（3-羟基-3-甲基戊二酰辅酶A）还原酶抑制剂与体外HELP血液分离术联合使用，以同时将低密度脂蛋白（LDL）和血浆纤维蛋白原清除至理想的血浆浓度。单独使用HELP治疗时，LDL胆固醇和纤维蛋白原可降至原始血浆水平的约50%-60%；单独使用HMG-CoA还原酶抑制剂药物可使LDL胆固醇较未治疗值平均降低40%。两种方法联合使用可使LDL胆固醇值降低70%-80%。这种联合治疗在冠心病（CAD）患者中的高效性和安全性使得即使是血浆LDL浓度约为450mg/dl的明显严重杂合子高胆固醇血症也有可能恢复至理想的LDL水平，即低于120mg/dl。如果通过饮食和药物治疗不能充分降低血浆胆固醇水平，这种治疗策略可能对有或没有家族性高胆固醇血症的CAD患者的二级预防有用。推测可能需要一到两年的治疗来延缓CAD进展，并可能使冠状动脉硬化发生逆转。
