- 期刊
高脂血症之雙重過濾血漿分離療法
Double-filtration Plasmapheresis in Hyperlipidemia
摘要
Recent researchers have demonstrated regular plasmapheresis is effective in the treatment of patients with severe hyperlipidemia on the aspects of the reduction of serum low-density lipoprotein (LDL) level, the regression of atherosclerotic plaques and concomitant improvement in the ischemic changes on electrocardiograph. We treated 7 severe hyperlipidemic male patients with double-filtration plasmapheresis (DF) for single session and compared the hematological changes before and after treatment. The removal rate was highest for triglyceride (53.8%), followed by cholesterol (39.9%) and globulin (21.4%). There were no significant changes in albumin, high-density lipoprotein cholesterol and platelet. A mild increase of white blood cell count was noted after DF treatment. LDL cholesterol level could not measured exactly in 6 out of 7 patients due to the interference of lipemia. The transmembrane pressure (TMP) had been above the ideal level (50 mmHg) during the first half period of treatment in 6 patients. In the 5 patients with TMP ＞130 mmHg, 2 patients got hemolysis and 1 patient had to renew the second plasma separator for further plasmapheresis. In contrast, the pressure of plasma fractionator had been kept within normal limits in all cases. As compared to the literature, the removal rates of serum lipid were lower in our series, which might be related to the early saturation of the plasma separator resulted from the extremely high level of triglyceride-containing lipoproteins (very low density lipoprotein or chylomicron). Therefore, plasmapheresis with centrifugation method may be more suitable in the initial treatment of severe hypertriglyceridemia to prevent the plugging phenomenon with filtration method. Besides, then the plasma fractionator with a smaller pore size may be more efficient for the removal of serum lipids.
並列摘要
Recent researchers have demonstrated regular plasmapheresis is effective in the treatment of patients with severe hyperlipidemia on the aspects of the reduction of serum low-density lipoprotein (LDL) level, the regression of atherosclerotic plaques and concomitant improvement in the ischemic changes on electrocardiograph. We treated 7 severe hyperlipidemic male patients with double-filtration plasmapheresis (DF) for single session and compared the hematological changes before and after treatment. The removal rate was highest for triglyceride (53.8%), followed by cholesterol (39.9%) and globulin (21.4%). There were no significant changes in albumin, high-density lipoprotein cholesterol and platelet. A mild increase of white blood cell count was noted after DF treatment. LDL cholesterol level could not measured exactly in 6 out of 7 patients due to the interference of lipemia. The transmembrane pressure (TMP) had been above the ideal level (50 mmHg) during the first half period of treatment in 6 patients. In the 5 patients with TMP ＞130 mmHg, 2 patients got hemolysis and 1 patient had to renew the second plasma separator for further plasmapheresis. In contrast, the pressure of plasma fractionator had been kept within normal limits in all cases. As compared to the literature, the removal rates of serum lipid were lower in our series, which might be related to the early saturation of the plasma separator resulted from the extremely high level of triglyceride-containing lipoproteins (very low density lipoprotein or chylomicron). Therefore, plasmapheresis with centrifugation method may be more suitable in the initial treatment of severe hypertriglyceridemia to prevent the plugging phenomenon with filtration method. Besides, then the plasma fractionator with a smaller pore size may be more efficient for the removal of serum lipids.
延伸閱讀
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- 洪偉君、李達濱、黃慧明（2021）。聯合血液淨化治療高脂血症性胰腺炎療效的Meta分析。鏡湖醫學，21(1)，17-21。https://www.airitilibrary.com/Article/Detail?DocID=P20230317001-N202303220009-00004
- 葉建宏、陳俊榮、溫武慶、沈幸梅、李美芬、邱浩彰（1998）。Waldenström巨球蛋白血症合併高粘度症候群之積極性雙重過濾血漿分離療法。台灣醫學，2(2)，141-147。https://doi.org/10.6320/FJM.1998.2(2).03
- 廖嘉勇、李香粉、鄭玉新、溫力立（2003）。利用Ethyl Acetate去除因高血脂引起生化檢驗監測之干擾。健康管理學刊，1(1)，39-49。https://www.airitilibrary.com/Article/Detail?DocID=a0000068-200306-1-1-39-49-a
- 邱浩彰、葉建宏（2000）。Plasmapheresis in Myasthenia Gravis。台灣醫學，4(5)，524-527。https://doi.org/10.6320/FJM.2000.4(5).06