达利（DALI）和莫奈（MONET）降脂的疗效。

Efficacy of lipid reduction with DALI and MONET.

作者信息

Ramlow Wolfgang, Röseler Eberhard, Heigl Franz, Spitthöver Ralf, Ringel Jens, Schmitz Gerd, Heinzler Rainer, Abdul-Rahman Nadim, Leistikow Frank, Himmelsbach Frido, Schettler Volker, Pham Jenny, Kozik-Jaromin Justyna

机构信息

Apherese Centrum Rostock (ACR), Nobelstraße 53, Rostock, Germany.

Zentrum für Nieren-, Hochdruck und Stoffwechselerkrankungen, Heidering 31, Hannover, Germany.

出版信息

Atheroscler Suppl. 2017 Nov;30:217-224. doi: 10.1016/j.atherosclerosissup.2017.05.035. Epub 2017 Jun 1.

DOI:10.1016/j.atherosclerosissup.2017.05.035

PMID:29096841

Abstract

BACKGROUND

Lipidapheresis techniques are increasingly used to treat drug-resistant hyperlipidemia but few efficacy studies under routine application are available. In this multicenter observational study we investigated direct adsorption of lipoproteins (DALI) and lipoprotein filtration (MONET) for the short and the long-term effects on lipid-lowering effects.

METHODS

Data of 122 apheresis patients from 11 centers (DALI: n = 78, MONET: n = 44) were prospectively collected for a period of 2 years. Routine lipid measurements were evaluated (2154 DALI and 1297 MONET sessions). It was investigated whether the relative reduction of LDL-C during apheresis session achieves at least 60%. Also relative reduction of total cholesterol, HDL, triglyceride, and Lp(a) were analyzed.

RESULTS

The relative reduction of LDL-C was at least 60%: DALI: 70.62%, 95% CI = [69.34; 71.90] and MONET: 64.12%, 95% CI = [60.79; 67.46]. Also triglycerides were reduced with both systems: DALI 38.63%, 95% CI = [33.95; 43.30] vs. MONET 57.68%, 95% CI = [51.91; 63.45]. Relative reductions of total cholesterol were in the range of 50% (DALI 95% CI = [46.49; 49.65] MONET 95% CI = [48.93; 55.26]) and of Lp(a) in the range of 65% (DALI 95% CI = [61.92; 65.83] MONET 95% CI = [63.71; 70.30]. HDL reduction was: DALI 15.01%, 95% CI = [13.22; 16.79] and MONET 22.59%, 95% CI = [19.33; 25.84]. For both devices treated patient plasma/blood volume and in case of DALI the use of the larger adsorber configurations (DALI 1000 and DALI 1250) were independent positive predictors of the relative reduction of LDL-C and of Lp(a).

CONCLUSIONS

Both systems effectively improved lipid profile and reduced atherogenic lipids. The results point to the importance of the individualized application of these valuable therapies to achieve clinical targets.

摘要

背景

脂质分离技术越来越多地用于治疗耐药性高脂血症，但常规应用下的疗效研究较少。在这项多中心观察性研究中，我们调查了脂蛋白直接吸附法（DALI）和脂蛋白过滤法（MONET）对降脂效果的短期和长期影响。

方法

前瞻性收集了来自11个中心的122例血液分离患者的数据（DALI组：n = 78，MONET组：n = 44），为期2年。评估常规血脂测量结果（2154次DALI治疗和1297次MONET治疗）。研究了血液分离治疗期间低密度脂蛋白胆固醇（LDL-C）的相对降低是否至少达到60%。还分析了总胆固醇、高密度脂蛋白、甘油三酯和脂蛋白（a）[Lp(a)]的相对降低情况。

结果

LDL-C的相对降低至少为60%：DALI组为70.62%，95%置信区间（CI）= [69.34；71.90]；MONET组为64.12%，95%CI = [60.79；67.46]。两种系统都能降低甘油三酯：DALI组降低38.63%，95%CI = [33.95；43.30]，MONET组降低57.68%，95%CI = [51.91；63.45]。总胆固醇的相对降低幅度在50%左右（DALI组95%CI = [46.49；49.65]，MONET组95%CI = [48.93；55.26]），Lp(a)的相对降低幅度在65%左右（DALI组95%CI = [61.92；65.83]，MONET组95%CI = [63.71；70.30]）。高密度脂蛋白的降低情况为：DALI组降低15.01%，95%CI = [13.22；16.79]，MONET组降低22.59%，95%CI = [19.33；25.84]。对于两种设备治疗的患者血浆/血容量，以及在DALI治疗中使用较大吸附器配置（DALI 1000和DALI 1250）是LDL-C和Lp(a)相对降低的独立阳性预测因素。