Gordon B R, Sloan B J, Parker T S, Saal S D, Levine D M, Rubin A L
Rogosin Institute, New York Hospital-Cornell Medical Center, New York.
Transfusion. 1990 May;30(4):327-32. doi: 10.1046/j.1537-2995.1990.30490273441.x.
Low-density lipoprotein apheresis (LDL-apheresis) is an extracorporeal procedure that preferentially removes LDL cholesterol from the blood. One of the primary techniques for performing this procedure uses immunoadsorption columns containing monospecific polyclonal sheep antibodies to human LDL covalently coupled to a gel filtration medium. LDL-apheresis has generally been well-tolerated, with chills, fever, or flushing occurring rarely. The possibility of an immune reaction was investigated as a basis for these reactions observed in 12 of the 1312 procedures performed. Antibodies to sheep IgG developed in 12 of the 15 patients treated with LDL-apheresis as a result of the shedding of small quantities of the sheep immunoglobulin from the columns. A column acid-washing procedure minimized the quantity of shed antibody but did not prevent immunization of the patient. The clinical reactions were probably unrelated to shedding and immunization, as the reactions occurred even in patients who were not immunized to the sheep IgG. Immunization to ethylene oxide was not the cause, as determined by a radioallergosorbent test. The reactions were more likely related to the activation of complement, as indicated by the generation of C3a des Arg by the columns and an increase in C3a des Arg levels systemically.
低密度脂蛋白单采术（LDL单采术）是一种体外操作程序，可优先从血液中去除低密度脂蛋白胆固醇。执行该程序的主要技术之一是使用免疫吸附柱，该柱含有与人低密度脂蛋白共价偶联到凝胶过滤介质上的单特异性多克隆羊抗体。LDL单采术一般耐受性良好，寒战、发热或潮红很少发生。在1312例操作中的12例中观察到这些反应，以此为基础对免疫反应的可能性进行了研究。由于柱中少量羊免疫球蛋白脱落，接受LDL单采术治疗的15例患者中有12例产生了抗羊IgG抗体。柱酸洗程序可减少脱落抗体的量，但不能防止患者免疫。临床反应可能与脱落和免疫无关，因为即使在未对羊IgG免疫的患者中也会出现反应。经放射变应原吸附试验确定，环氧乙烷免疫不是原因。这些反应更可能与补体激活有关，如柱产生C3a去精氨酸以及全身C3a去精氨酸水平升高所示。
