Ezhov Marat V, Il'ina Larisa N, Safarova Maya S, Afanasieva Olga I, Adamova Irina Yu, Atanesyan Ruslan V, Konovalov Gennadiy A, Akchurin Renat S, Pokrovsky Sergei N
Cardiology Research Center, 15a, 3rd Cherepkovskaya Street, 121552 Moscow, Russia.
Atheroscler Suppl. 2013 Jan;14(1):101-5. doi: 10.1016/j.atherosclerosissup.2012.10.014.
To evaluate the effect of a 12-month course of weekly lipid apheresis on vein graft patency after coronary artery bypass grafting (CABG) in patients with hyperlipidemia refractory to statins.
In a 12-month prospective controlled clinical trial we enrolled 34 male patients (mean age 57 ± 8 years) who passed through successful CABG and low-density lipoprotein cholesterol (LDL-C) level >2.6 mmol/L prior to the operation despite statin treatment. Patients were allocated into 2 groups: active (n = 17, weekly apheresis by cascade plasma filtration (CPF) plus atorvastatin), and control (n = 17, atorvastatin alone). Graft patency was evaluated by multislice computed tomography at 3 months and by angiography at 12 months after an operation.
Both groups were comparable in clinical and biochemical characteristics. During each CPF procedure, LDL-C level decreased by 64 ± 9%, apoB - by 65 ± 8%, Lp(a) - by 52 ± 15%,; these changes were significant compared to baseline and the control group. Mean net difference in LDL-C level between apheresis and control groups was 1.1 ± 0.3 mmol/L. Vein graft patency at study end was 88.2% (45 of 51) in the apheresis group versus 72.7% (40 of 55) in the control group (p = 0.05). Use of apheresis was associated with decreased vein graft occlusions by 46%: relative risk 0.54; 95% confidence interval 0.27 to 1.02; p = 0.05.
Our data suggest that the use of lipoprotein apheresis with CPF results in a better vein graft patency during the first year after CABG in patients with hyperlipidemia refractory to statins.
评估为期12个月的每周一次脂质分离术对他汀类药物治疗无效的高脂血症患者冠状动脉旁路移植术（CABG）后静脉移植物通畅情况的影响。
在一项为期12个月的前瞻性对照临床试验中，我们纳入了34例男性患者（平均年龄57±8岁），这些患者CABG手术成功，且术前尽管接受了他汀类药物治疗，但低密度脂蛋白胆固醇（LDL-C）水平仍>2.6 mmol/L。患者被分为两组：治疗组（n = 17，采用级联血浆滤过（CPF）每周进行一次血液成分分离术加阿托伐他汀）和对照组（n = 17，仅使用阿托伐他汀）。术后3个月通过多层计算机断层扫描评估移植物通畅情况，术后12个月通过血管造影评估。
两组在临床和生化特征方面具有可比性。在每次CPF过程中，LDL-C水平下降了64±9%，载脂蛋白B下降了65±8%，脂蛋白（a）下降了52±15%；与基线水平和对照组相比，这些变化具有显著性。血液成分分离术组和对照组之间LDL-C水平的平均净差异为1.1±0.3 mmol/L。研究结束时，血液成分分离术组静脉移植物通畅率为88.2%（51例中的45例），对照组为72.7%（55例中的40例）（p = 0.05）。使用血液成分分离术可使静脉移植物闭塞率降低46%：相对风险为0.54；95%置信区间为0.27至1.02；p = 0.05。
我们的数据表明，对于他汀类药物治疗无效的高脂血症患者，在CABG术后第一年，采用CPF进行脂蛋白分离术可使静脉移植物通畅情况更佳。
