低密度脂蛋白血液净化治疗高脂血症性疾病进展

全面介绍低密度脂蛋白血液净化治疗高脂血症性疾病的方法、临床应用及血液净化材料的进展状况     

连续性血液净化治疗急性高钠高氯血症

目的观察连续性血液净化治疗急性高钠高氯血症的疗效。方法对20例高钠高氯血症患者给予连续性血液净化治疗,观察治疗前后的血清钠血清氯浓度及纠正速度、血压、神志等改变。结果连续性血液净化治疗24～72h/次,共治疗28例次,救治成功13例,死亡6例,放弃治疗1例,有效率65%。结论连续性血液净化是治疗急性高钠高氯血症的有效措施,临床上应尽早采用此法。     

血液净化治疗百草枯中毒疗效观察

目的比较血液灌流与血液灌流联合连续性血液净化治疗百草枯中毒的疗效。方法 69例百草枯中毒患者分组后分别给予血液灌流、血液灌流联合连续性血液净化治疗,观察其3月内疗效。结果血液灌流组39例患者中死亡28例,好转11例,有效率为28.20%;血液灌流联合连续性血液净化组30例患者中死亡14例,好转16例,有效率53.33%。血液灌流联合连续性血液净化治疗百草枯中毒的有效率较血液灌流有效率高（P=0.034）。结论血液灌流联合连续性血液净化治疗百草枯中毒是比血液灌流更为有效的治疗方式。     

中毒患者实施血液灌流联合血液透析的急救护理

目的探讨36例各种毒物中毒的血液净化方法与净化中的护理方法。方法使用单泵血液透析机和健帆F230血液灌流器和F14透析器对36例中毒患者进行HP或HP-HD采取的急救措施、及血液净化中、后护理。结果治愈率高,住院时间短,病死率低。结论 HP及HP-HD净化中的护理有助于减轻患者痛苦,是抢救急性中毒的关键。     

高流量连续血液净化在急性重症胰腺炎急性反应期的应用研究

目的探讨高流量连续血液净化对急性重症胰腺炎急性反应期的疗效及预后的影响。方法将急性重症胰腺炎急性反应期的患者25例，随机分为血液净化组（13例）、对照组（12例），血液净化组给予常规治疗，同时给予连续72h高流量血液净化治疗；对照组只给予常规治疗。结果与对照组比较，血液净化组机械通气时间、ICU内治疗时间短，28d病死率低，其中ICU内治疗时间比较，2组差异具有统计学意义（P〈0．05）。与对照组同期比较，血液净化组治疗72h后APACHEII评分和MARSHALL评分以及TNF—α、IL-6均明显下降，差异有统计学意义（P〈0．01或P〈0．05）。结论高流量连续血液净化能够有效的清除机体内的非特异细胞因子，具有减轻急性重症胰腺炎急性反应期患者的全身炎性反应，可改善患者临床预后。     

动静脉直接穿刺在血液净化中的应用

血液净化是目前抢救肾衰、急性中毒、慢性肾衰竭出现严重高血钾、急性左心衰竭、肺水肿等的一种有效方法。如何迅速建立血管通路,确保足够的血流量以取得血液净化疗效,是抢救成功的关键。自1997年10月以来,我院血透室在临床急诊中应用动静脉直接穿刺建立临时性血液通路,进行血液净化共37例、231人次,取得了满意疗效。     

血液净化治疗蜂蜇伤13例体会

血液净化不仅是治疗肾衰竭的主要方法，也是治疗某些急性中毒的方法之一，且疗效确切。我院血液净化中心自2006年以来，用血液净化方法救治蜂蜇伤患者13例，效果良好，报告如下。     

HA型血液灌流器与透析器串联对治疗慢性衰竭患者血脂的影响

目的观察血液灌流对血液透析患者血脂[LP（α）]的影响。方法选取多个血液净化中心血液透析患者40例,比较单次血液透析串联血液灌流前后患者血脂的变化。结果慢性肾衰竭患者多数存在血脂代谢的紊乱,血液灌流后学[Lp（a）]以及甘油三酯（TG）的浓度下降,高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白A（APOA）、载脂蛋白B（APOB）、总胆固醇（TC）的浓度无明显变化。结论血液灌流可以降低维持性血液透析患者的Lp（a）及TG,改善其脂代谢紊乱。     

血液净化中心潜在护理安全隐患与消毒隔离的管理方法改进

目的探讨血液净化中心潜在护理安全隐患,改进消毒隔离的管理方法。方法选取2018年1月至2018年8月,来我院血液净化中心治疗的60例患者作为研究组,选取2017年1月至2017年12月,来我院血液净化中心治疗的60例患者作为对照组,比较两组患者在接受血液净化治疗期间,对血液净化中心护理服务的满意度差异。结果对照组患者对于常规护理模式的满意度为78.33%;研究组患者对于改进消毒管理方法后的护理模式的满意度为95.00%,明显高于对照组,经比较,P<0.05,差异具有统计学意义。血液净化中心潜在的护理安全隐患包括:环境因素、工作人员因素及患者因素等,改进的消毒隔离管理方法包括:合理布局血液净化中心、做好室内消毒管理、做好设备管理及人员管理等。结论加强对于血液净化中心的消毒隔离管理,不仅可以提高安全意识,减少潜在的护理安全隐患,还通过改进消毒隔离管理方法,提高了患者对于血液净化中心护理服务的满意度。     

4388例次血液净化治疗的临床总结

目的：总结血液净化治疗的临床应用价值。方法：采用血液透析，血液滤过，血液灌流、血浆交换等血液净化技术，对２５１例急，慢性肾功能衰竭，系统性红斑狼疮及多器官功能衰竭的患者进行４３８８例次血液净化治疗。     

Defining the Role of Lipoprotein Apheresis in the Management of Familial Hypercholesterolemia

Familial hypercholesterolemia (FH) is an autosomal co-dominant disorder characterized by a marked elevation of serum low-density lipoprotein (LDL) cholesterol (LDL-C) concentration, which in turn is associated with a greatly increased risk of premature cardiovascular disease. International consensus recommends the use of statins as the first line of treatment for patients with this condition. However, homozygote FH patients with persistently elevated LDL-C levels are usually resistant to multiple-drug therapy. Fortunately, LDL apheresis (or simply ‘lipoprotein apheresis’) provides a treatment option for patients who are refractory or intolerant to lipid-lowering medications, or if there is progressive cardiovascular disease despite maximal drug therapy. Lipoprotein apheresis is an extracorporeal LDL-C-lowering treatment similar in concept to renal dialysis. There are now five main methods for extracorporeal lipoprotein apheresis in use, namely dextran sulfate adsorption (DSA), heparin extracorporeal LDL precipitation (HELP), polyacrylate full blood adsorption (PFBA or DALI® system) using hemoperfusion, immunoadsorption, and filtration plasmapheresis. Lipoprotein apheresis has been shown to be successful in reducing LDL-C levels, as well as levels of lipoprotein(a) [Lp(a)], a prothrombotic proatherogenic lipoprotein. In contrast, however, lipoprotein apheresis seems to have a smaller effect in preventing atherosclerosis progression, thus suggesting that a major component of the reduction in cardiovascular events may be mediated by mitigating Lp(a) levels. Side effects are infrequent and mild, and have mainly consisted of lightheadedness, nausea, vomiting, and hypotension. As these are often bradykinin-mediated and associated with concomitant ACE inhibitor use, angiotensin type 2 receptor antagonists should be used instead of ACE inhibitors with DALI and PFBA. Nevertheless, there is scope for wider application of lipoprotein apheresis. The high cost and invasive nature of lipoprotein apheresis limits uptake; however, it is an important treatment modality that should be considered in carefully selected patients. National and international registries compiling outcome data for lipoprotein apheresis need to be established to help expand the evidence base regarding its effectiveness.     

LDL Apheresis: an effective and safe treatment for refractory hypercholesterolemia

Through the efforts of Edward H. Ahrens, LDL apheresis became available for the treatment of patients, often with familial hypercholesterolemia, who have no alternative therapy for severely elevated LDL cholesterol levels. In the U.S., the FDA has approved this treatment for individuals on maximum diet and drugs with an LDL cholesterol greater than 300 mg/dL or greater than 200 mg/dL with coronary artery disease. Unlike plasmapheresis, apolipoprotein B-containing lipoproteins (LDL, Lp(a), and VLDL) are selectively removed by heparin precipitation or columns containing dextran sulfate cellulose or antibodies to apolipoprotein B. The acute lowering of LDL-cholesterol by a typical 2 - 3 h treatment is up to 80%, and the time-averaged lowering in the 1 to 2 week interval between treatments is up to 50%, with very few side effects. The lowering of LDL-cholesterol and other cardioprotective effects of LDL apheresis have reduced chest pain, prevented new disability and prolonged life. Whole blood compatible columns in development offer the possibility of simpler and less expensive treatments.     

The potential of mipomersen,an ApoB synthesis inhibitor,to reduce necessity for LDL-apheresis in patients with heterozygous familial hypercholesterolemia and coronary artery disease

Introduction: LDL-apheresis is a treatment option for familial hypercholesterolemia (FH) with country-specific thresholds for LDL-cholesterol (LDL-C) for initiation. Apheresis also reduces lipoprotein(a) [Lp(a)] and may be used to lower Lp(a) in high-risk patients. Mipomersen, an apolipoproteinB-synthesis-inhibitor, reduces LDL-C and Lp(a). We hypothesized that mipomersen may prevent the necessity for apheresis by reducing the both below thresholds.

Methods: Data from a study in 123 patients with heterozygous FH and coronary artery disease on maximally tolerated lipid-lowering therapy were used to evaluate in what percentage adding mipomersen resulted in lipid-levels below apheresis-thresholds. Different thresholds were tested: LDL-C ≥ 2.59 mmol/l, ≥ 3.36 mmol/l, ≥ 4.14 mmol/l, Lp(a) ≥ 60 mg/dl.

Results: Mipomersen decreased LDL-C by 28% (baseline 153 mg/dl), Lp(a) by 21% (baseline 45 mg/dl) (placebo no effect). Mipomersen reduced the percentage of patients with LDL-C ≥ 4.14 mmol/l from 39 to 2%, with LDL ≥ 3.36 mmol/l from 62 to 16%, with LDL ≥ 2.59 mmol/l from 98 to 54%, and with Lp(a) ≥ 60 mg/dl from 39 to 23%.

Summary: When added to maximally tolerated lipid-lowering therapy, mipomersen may reduce the necessity for apheresis in many of these patients. In Germany, the threshold for apheresis for LDL typically is 2.59 mmol/l, for Lp(a) 60 mg/dl. Almost 50% of the patients could avoid apheresis with the addition of mipomersen. Further studies are warranted to evaluate whether patients who qualify for apheresis could be adequately controlled with mipomersen.     

Elimination kinetics of quinaprilat and perindoprilat in hypertensive patients with renal failure on haemodialysis

Objective of the present study was to investigate the elimination kinetics of quinaprilat and perindoprilat, the active metabolites of angiotensin-converting enzyme (ACE) inhibitors quinapril and perindopril, in hypertensive patients with renal failure under haemodialysis to evaluate the appropriate duration of off-dose of these drugs before starting of low-density lipoprotein (LDL) apheresis. The informed consent was received from 12 hypertensive patients with renal failure, who were under haemodialysis (42 to 62 years). The patients received oral administration of quinapril (10 mg) or perindopril (2 mg) once a day for four weeks. First, to evaluate the dialyzability of each metabolite, blood samples were collected before and after haemodialysis one week after the repeated doses. Second, to evaluate the elimination kinetics of quinaprilat or perindoprilat, blood samples were collected at 24, 72, 120, 192 and 240 h after the final administration. Plasma concentrations of quinaprilat and perindoprilat were measured by high-performance liquid chromatography (HPLC) and radioimmunoassay, respectively. Pharmacokinetic parameters were determined by a model-dependent method. Values of haemodialysis clearance (CL(HD)) and extraction ratio (ER) were 51.5+/-30.2 ml/min and 0.35+/-0.21 for quinaprilat and 108.1+/-5.9 ml/min and 0.75+/-0.04 for perindoprilat, respectively. The terminal elimination half-lives of quinaprilat and perindoprilat were 60.7+/-2.1 and 79.9+/-14.0 h, respectively. The dialyzability of perindoprilat was much higher than that of quinaprilat probably due to low protein binding potency. The present study suggests that hypertensive patients receiving chronic therapy with quinapril or perindopril on haemodialysis should be withdrawn for at least 2 to 3 weeks before LDL apheresis.     

去白细胞机采血小板的临床疗效分析

目的探讨分析去白细胞机采血小板与单纯机采血小板的临床治疗效果。方法回顾性分析新疆维吾尔自治区乌鲁木齐市血液中心653例去白细胞机采血小板与单纯机采血小板的治疗效果。结果去白细胞机采血小板组输注总有效率为91．6％,单纯机采血小板组为89．9％;去白细胞机采血小板组发生输血反应及血小板无效输注低于单纯机采血小板组（P〈0．05）。结论去白细胞机采血小板输注疗效较手工分离血小板更为安全有效。     

单采血小板耗材报废原因分析

目的:了解血小板耗材报废原因。方法:对2010年1—12月成都市血液中心单采血小板耗材报废原因进行分类、统计和分析。结果:共使用7 236套耗材,报废123套耗材,报废率1.70%。单采血小板耗材报废主要原因依次为脂血、冲红、献血反应、机器故障和耗材问题。结论:机采血小板耗材报废大多与献血者或操作因素有关,通过加强血小板招募时的宣传教育,严格操作规程,加强操作人员技术培训和仪器的维护,可减少单采血小板耗材的报废率。     

血站机采操作人员心理健康状况分析

目的:研究血站机采操作人员的心理健康状况。方法:使用心理压力源表和症状评定量表(SCL-90)对106名机采操作人员进行问卷调查,对调查结果进行分析。结果:机采操作人员的心理压力源在工作性质及强度方面、人际关系方面和家庭方面有显著差异,心理健康水平低于普通人群。从SCL-90得分情况分析,机采操作人员的躯体化、强迫、抑郁、焦虑、敌对和精神病性6个因子和总分上的得分高于全国常模,其中躯体化、抑郁和强迫最突出。结论:机采操作人员存在较大的心理压力和较多的心理健康问题,应采取有效的心理干预缓解其心理压力,以增进机采操作人员的身心健康。     

Granulocyte and monocyte adsorptive apheresis in the treatment of active distal ulcerative colitis: a prospective, pilot study

AIM: To assess safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis for distal ulcerative colitis. METHODS: Granulocyte and monocyte adsorptive apheresis therapy (five aphereses for 5 consecutive weeks) was performed for 30 consecutive patients with active distal ulcerative colitis. Patient compliance, adverse effects and clinical symptoms were regularly assessed. RESULTS: Adverse effects were noted during nine (6%) apheresis sessions in eight patients; slight headache five, transient abdominal pain with tenesmus two, fever (38 degrees C) one and mild liver dysfunction one. None of these adverse effects was serious and all patients could complete five aphereses. Clinical symptoms (stool frequency and consistency, rectal bleeding, tenesmus and mucus in stools) significantly improved after the third apheresis. Clinical remission (normal stool frequency and no rectal bleeding) was achieved in 21 patients (70%) after five aphereses. The median Disease Activity Index score significantly decreased; from 6 [interquartile range (IQR): 4-7] to 2 (IQR: 1-3) (P < 0.0001). CONCLUSION: In the treatment of active distal ulcerative colitis, granulocyte and monocyte adsorptive apheresis is safe and well-tolerated. Granulocyte and monocyte adsorptive apheresis had a beneficial effect on clinical remission and symptoms. However, randomized-controlled trials would be necessary to assess a definite efficacy of granulocyte and monocyte adsorptive apheresis.     

Gene therapy for familial hypercholesterolemia

Familial hypercholesterolemia (FH) is an inherited metabolic disorder characterized by high levels of plasma low density lipoproteins (LDL) and an increased risk of premature atherosclerosis and coronary heart disease. LDL receptor (LDLr) deficiency is the most prevalent cause of FH. Therefore, hepatocyte-directed LDLr gene transfer constitutes an important strategy for the treatment of this monogenetic disease. Nowadays, homozygous FH patients are treated with lipid-lowering drugs complemented by plasma or LDL apheresis. Liver transplantation can restore metabolism of apolipoprotein B containing lipoproteins, but requires lifelong immunosuppression to prevent organ rejection. Recently, significant progress in gene transfer technology has encouraged investigators to further develop LDLr gene transfer approaches for the treatment of FH. In experimental animal models of FH, LDLr overexpression following viral vector-based gene transfer has been shown to be associated with long-term stable correction of hyperlipidemia, with attenuation of atherosclerosis progression, and in certain cases even with lesion regression. The first part of this review provides a thorough overview of familial hypercholesterolemia including its diagnosis, lipoprotein metabolism, and current management. In the second part, we critically review experimental LDLr gene transfer studies demonstrating the progress that has been made from the initial proof of principle studies to recent investigations showing dramatic regression of atherosclerosis in experimental models.     

机采新鲜血小板与冰冻血小板在临床上应用评价

目的 探讨新鲜血小板的临床应用效果,以弥补急救时新鲜血小板供应不足。方法 采用机采新鲜血小板与冰冻血小板临床输注疗效分析,随机分为2组对照,观察血小板输注前后的临床体征及血小板计数。结果 2组疗效分析,机采新鲜血小板组疗效优于新鲜冰冻血小板组。结论 机采新鲜血小板可以用于急救由于血小板减少导致的出血性疾病。