Park J W, Merz M, Braun P
Herzzentrum Duisburg Kaiser-Wilhelm-Krankenhaus, Germany.
Atherosclerosis. 1998 Aug;139(2):401-9. doi: 10.1016/s0021-9150(98)00092-6.
In the secondary prevention of coronary artery disease (CAD) the beneficial effect of lipid lowering is no longer controversial. LDL-apheresis is a feasible therapy for effective lipid lowering in patients refractory to diet and cholesterol lowering drugs. To assess the impact of the HELP-therapy (heparin-induced, extracorporeal LDL precipitation) on patients' clinical outcome and coronary angiography, we set up a prospective trial, in which patients with advanced coronary atherosclerosis and severe hypercholesterolemia resistant to diet and drug therapy were treated with LDL-apheresis. A total of 44 patients were treated with adjunctive weekly HELP-therapy for 15.5 +/- 9.5 months. The mean levels of total cholesterol (Chol), LDL-cholesterol (LDL-C), Lp(a), and fibrinogen at baseline were 308.0 +/- 69.7, 231.8 +/- 72.7, 82.2 +/- 54.1, and 356.1 +/- 94.1 mg/dl, respectively. LDL-apheresis caused a mean per treatment reduction of 44.8 +/- 8.7, 55.5 +/- 8.6, 60.8 +/- 10.2, and 53.8 +/- 6.5% of Chol, LDL-C, Lp(a), and fibrinogen, resulting in mean treatment interval values of 190.4 +/- 33.7, 116.3 +/- 28.9, 51.9 +/- 33.1, and 213.7 +/- 148.9 mg/dl, respectively. Improvement of the clinical status (exercise tolerance, anti-anginal drug use, angina pectoris) was found in 73%, no change in 11%, and deterioration in 16% of the cases. Four patients died cardiac death. The maximal bicycle exercise work load of the patients increased significantly from 101 +/- 41 to 119 +/- 46 W (P < 0.001). Ten (40%) out of 25 patients who underwent follow-up angiography revealed CAD progression, whereas two (8%) patients had CAD regression. Despite angiographic deterioration eight out of ten progressors (80%) improved clinically. In patients with advanced coronary atherosclerosis and severe hypercholesterolemia HELP-therapy can safely and effectively lower LDL-C, Lp(a), and fibrinogen. The chronic weekly HELP-treatment results in clinical improvement in the majority of patients, even in those patients with angiographically shown CAD progression.
在冠状动脉疾病（CAD）的二级预防中，降脂的有益作用已不再有争议。低密度脂蛋白清除术是一种可行的治疗方法，可有效降低对饮食和降胆固醇药物治疗无效患者的血脂。为了评估HELP治疗（肝素诱导的体外低密度脂蛋白沉淀）对患者临床结局和冠状动脉造影的影响，我们开展了一项前瞻性试验，对患有晚期冠状动脉粥样硬化和对饮食及药物治疗耐药的严重高胆固醇血症患者进行低密度脂蛋白清除术治疗。共有44例患者接受了辅助性每周一次的HELP治疗，持续15.5±9.5个月。基线时总胆固醇（Chol）、低密度脂蛋白胆固醇（LDL-C）、脂蛋白（a）[Lp(a)]和纤维蛋白原的平均水平分别为308.0±69.7、231.8±72.7、82.2±54.1和356.1±94.1mg/dl。每次低密度脂蛋白清除术可使Chol、LDL-C、Lp(a)和纤维蛋白原的平均水平分别降低44.8±8.7%、55.5±8.6%、60.8±10.2%和53.8±6.5%，治疗间隔期的平均水平分别为190.4±33.7、116.3±28.9、51.9±33.1和213.7±148.9mg/dl。73%的病例临床状况得到改善（运动耐量、抗心绞痛药物使用、心绞痛），11%无变化，16%恶化。4例患者死于心源性死亡。患者的最大自行车运动负荷从101±41W显著增加至119±46W（P<0.001）。在25例接受随访冠状动脉造影的患者中，10例（40%）显示CAD进展，而2例（8%）患者CAD有消退。尽管造影显示病情恶化，但10例病情进展患者中有8例（80%）临床状况得到改善。对于患有晚期冠状动脉粥样硬化和严重高胆固醇血症的患者，HELP治疗可安全有效地降低LDL-C、Lp(a)和纤维蛋白原。每周一次的长期HELP治疗可使大多数患者的临床状况得到改善，即使是那些冠状动脉造影显示CAD进展的患者。
