Bosch T
Klinikum Grosshadern, University of Munich, Germany.
Artif Organs. 1996 Apr;20(4):292-5. doi: 10.1111/j.1525-1594.1996.tb04447.x.
Currently, 5 different lipid apheresis procedures are available for routine clinical treatment of hypercholesterolemic patients. Unselective plasma exchange is a technically simple extracorporeal circuit, but albumin substitution fluid must be used and there is no high-density lipoprotein (HDL) recovery. Semiselective double filtration with improved size selectivity because of a small-pore secondary filter combines good elimination of low-density lipoprotein (LDL), lipoprotein (a) (Lp[a]), and fibrinogen with adequate HDL recovery; modifications such as thermofiltration, predilution/backflush, or pulsatile flow have been proposed for the improvement of this system. Three highly selective procedures are based on immunologic or electrostatic interactions: immunoadsorption using anti-low-density lipoprotein (LDL) antibodies, chemoadsorption onto dextran sulfate, and heparin-induced LDL precipitation (HELP) apheresis. The features of each system are discussed critically. Lastly, two new developments, Lp(a) immunoadsorption and LDL hemoperfusion using a polyacrylate LDL adsorber compatible with whole blood, are described.
目前，有5种不同的血脂分离程序可用于高胆固醇血症患者的常规临床治疗。非选择性血浆置换是一种技术上简单的体外循环，但必须使用白蛋白置换液，且不存在高密度脂蛋白（HDL）回收。半选择性双重过滤由于使用小孔径二级过滤器而具有改进的尺寸选择性，它能在充分回收HDL的同时，良好地清除低密度脂蛋白（LDL）、脂蛋白（a）[Lp（a）]和纤维蛋白原；有人提出了诸如热过滤、预稀释/反冲或脉动流等改进措施来优化该系统。三种高度选择性的程序基于免疫或静电相互作用：使用抗低密度脂蛋白（LDL）抗体的免疫吸附、硫酸葡聚糖上的化学吸附以及肝素诱导的LDL沉淀（HELP）血脂分离。对每个系统的特点进行了批判性讨论。最后，介绍了两项新进展，即使用与全血兼容的聚丙烯酸酯LDL吸附器进行Lp（a）免疫吸附和LDL血液灌流。
