Ramunni Alfonso, Brescia Paola, De Fino Giuseppina, Piscopo Giovanni, Gesualdo Loreto
Section of Nephrology, Department Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Clin Res Cardiol Suppl. 2012 Jun;7(Suppl 1):41-4. doi: 10.1007/s11789-012-0045-7.
In microcirculation disorders, the therapeutic apheresis seems to have two different effects. The first, achieved after only a few sessions, is acute, consisting of drastic reduction of blood viscosity and obtained with the use of low-density lipoprotein (LDL) apheresis, rheopheresis, or fibrinogen apheresis. The second effect is long term, or chronic, and needs to be evaluated after a long course of treatment. The mechanisms underlying the chronic effect are still objects of debate and take into account the pleiotropic effects of apheresis. However, it is likely that the acute effect of apheresis mainly influences the functional components of the vascular damage, and so the derived rheological benefit might last only for a short period. The chronic effect, on the contrary, by acting on the morphological alterations of the vascular walls, requires the apheresis treatment to be prolonged for a longer period or even cycles of treatment to be programmed.
在微循环障碍中，治疗性血液成分单采似乎有两种不同的效果。第一种效果在仅进行几次治疗后即可实现，是急性的，包括使用低密度脂蛋白（LDL）血液成分单采、血液流变学单采或纤维蛋白原血液成分单采大幅降低血液粘度。第二种效果是长期的，即慢性的，需要在长期治疗后进行评估。慢性效果的潜在机制仍是争论的焦点，且要考虑到血液成分单采的多效性。然而，血液成分单采的急性效果可能主要影响血管损伤的功能成分，因此由此产生的流变学益处可能仅持续较短时间。相反，慢性效果通过作用于血管壁的形态学改变，需要延长血液成分单采治疗时间，甚至规划多个治疗周期。
