Weiss Norbert
University Center for Vascular Medicine and Department of Medicine III, Section Angiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
Semin Dial. 2012 Mar-Apr;25(2):220-7. doi: 10.1111/j.1525-139X.2011.01036.x. Epub 2011 Dec 16.
Lipid apheresis effectively lowers LDL-cholesterol even in drug-unresponsive severely hypercholesterolemic patients. This results in improvement of symptoms of coronary artery disease, reduces progression of coronary atherosclerosis, and decreases coronary event rates. Besides aggressive lipid lowering itself, these effects may also be due to nonselective removal of other high molecular weight proteins leading to improved hemorheology. Lipid apheresis is also used for treating symptoms of vascular diseases outside the coronary arteries, such as peripheral arterial disease and the angioneuropathic diabetic foot syndrome. This review discusses putative effects of lipid apheresis and rheophereis on restoring pathophysiological processes involved in the development of symptoms of peripheral arterial disease, critical limb ischemia, and the diabetic foot syndrome. The clinical experience with lipid apheresis and rheopheresis in treating patients with peripheral arterial disease and the diabetic foot syndrome is critically reviewed and put into the context of currently available established treatment options. Based on this analysis, the limitations of current evidence are discussed and potential fields of research are suggested.
即使在对药物无反应的严重高胆固醇血症患者中，血脂分离术也能有效降低低密度脂蛋白胆固醇。这会改善冠状动脉疾病的症状，减少冠状动脉粥样硬化的进展，并降低冠状动脉事件发生率。除了积极的降脂作用本身外，这些效果也可能归因于非选择性去除其他高分子量蛋白质，从而改善血液流变学。血脂分离术还用于治疗冠状动脉以外的血管疾病症状，如外周动脉疾病和血管神经性糖尿病足综合征。本综述讨论了血脂分离术和血液稀释疗法对恢复外周动脉疾病、严重肢体缺血和糖尿病足综合征症状发展中所涉及的病理生理过程的假定作用。对血脂分离术和血液稀释疗法治疗外周动脉疾病和糖尿病足综合征患者的临床经验进行了严格审查，并将其置于当前可用的既定治疗选择的背景下。基于这一分析，讨论了当前证据的局限性，并提出了潜在的研究领域。
