Pokrovsky Sergei N, Afanasieva Olga I, Ezhov Marat V
'Russian Cardiology Research and Production Complex' of Ministry of Health of the Russian Federation, Moscow, Russia.
Curr Opin Lipidol. 2016 Aug;27(4):351-8. doi: 10.1097/MOL.0000000000000319.
Currently, different methods for extracorporeal elimination of atherogenic apolipoprotein B100 containing lipoprotein particles are used in clinical practice. Most of them effectively remove both lipoprotein(a) [Lp(a)] and LDL. The aim of this review is to highlight research describing the clinical advantages of specific Lp(a) immunosorption compared with other lipoprotein apheresis systems.
Data on the utility of lipoprotein apheresis in patients with elevated Lp(a) level are limited. However, several longitudinal studies demonstrated improvement in cardiovascular outcomes when both Lp(a) and LDL cholesterol levels were decreased with different apheresis systems. The main limitation of these trials is the absence of a control group. First developed in 1991, studies on apheresis with a specific immunosorbent to Lp(a) were small and noncontrolled before 2000s. The only prospective controlled clinical trial utilising Lp(a) apheresis (Clinicaltrials.gov NCT02133807), demonstrated regression of coronary and carotid atherosclerosis when Lp(a) was removed weekly for 18 months.
Lipoprotein apheresis usually affects multiple lipoproteins, and there are minimal data regarding the effect of specific removal of Lp(a) alone. There is a need for randomized controlled trial with specific Lp(a) apheresis to investigate its effect on cardiovascular outcomes.
目前，临床实践中使用了不同的体外清除含致动脉粥样硬化载脂蛋白B100脂蛋白颗粒的方法。其中大多数方法能有效清除脂蛋白(a)[Lp(a)]和低密度脂蛋白。本综述的目的是强调描述特定Lp(a)免疫吸附与其他脂蛋白分离系统相比临床优势的研究。
关于脂蛋白分离术在Lp(a)水平升高患者中的效用的数据有限。然而，几项纵向研究表明，当使用不同的分离术系统使Lp(a)和低密度脂蛋白胆固醇水平均降低时，心血管结局有所改善。这些试验的主要局限性是缺乏对照组。Lp(a)特异性免疫吸附分离术于1991年首次研发，在21世纪之前，相关研究规模较小且未设对照。唯一一项使用Lp(a)分离术的前瞻性对照临床试验（Clinicaltrials.gov NCT02133807）表明，当每周进行18个月的Lp(a)清除时，冠状动脉和颈动脉粥样硬化出现消退。
脂蛋白分离术通常会影响多种脂蛋白，而单独特异性清除Lp(a)的效果相关数据极少。需要开展关于特异性Lp(a)分离术的随机对照试验，以研究其对心血管结局的影响。
