Suzuki H, Mutoh E, Kitagawa T, Kubota H, Takasugi Y
Department of Internal Medicine, Asahikawa Municipal Hospital.
Hokkaido Igaku Zasshi. 1993 Jan;68(1):126-31.
We reported here a case of arteriosclerosis obliterans (ASO) in which clinical symptoms and signs were improved after repeated LDL apheresis. The patient was a 70-year-old man who was diagnosed as having ASO in 1989. Although drug treatment started for the arterial disease, such clinical manifestations as rubor and intermittent claudication were gradually worsening. In 1991, the patient was also found to have diabetes mellitus (DM), leading to admission for its treatment. Insulin therapy was initially required, but it finally became possible to maintain a good control of DM with diet therapy alone. Since hypercholesterolemia (402 mg/dl) was noted on admission, we began to give the patient pravastatin. In response to the medication, serum total cholesterol (TC) levels declined to 270 mg/dl, but no further improvement was obtained. We therefore decided to perform LDL apheresis on the patient, hoping the improvement of both ASO and hypercholesterolemia. After six series of LDL apheresis were performed during 4 weeks, ASO-related signs and symptoms (i. e., intermittent claudication) were remarkably improved, and serum TC levels were decreased below 200 mg/dl. Our experience in the present case suggested that this procedure would be useful as an effective choice of treatment for ASO, but further studies as to the indication and protocol of this therapeutic maneuver will be clearly needed.
我们在此报告一例闭塞性动脉硬化症（ASO）患者，其在多次进行低密度脂蛋白分离术之后临床症状和体征得到改善。该患者为一名70岁男性，于1989年被诊断为患有ASO。尽管针对该动脉疾病开始了药物治疗，但诸如皮肤发红和间歇性跛行等临床表现仍逐渐恶化。1991年，该患者还被发现患有糖尿病（DM），因此入院接受治疗。最初需要胰岛素治疗，但最终仅通过饮食疗法就能够很好地控制DM。由于入院时发现患者存在高胆固醇血症（402mg/dl），我们开始给患者服用普伐他汀。服药后，血清总胆固醇（TC）水平降至270mg/dl，但未获得进一步改善。因此，我们决定对该患者进行低密度脂蛋白分离术，希望能改善ASO和高胆固醇血症。在4周内进行了6次低密度脂蛋白分离术后，与ASO相关的体征和症状（即间歇性跛行）明显改善，血清TC水平降至200mg/dl以下。我们在本病例中的经验表明，该程序作为ASO的一种有效治疗选择可能是有用的，但显然还需要对这种治疗手段的适应证和方案进行进一步研究。
