高脂血症之雙重過濾血漿分離療法

Double-filtration Plasmapheresis in Hyperlipidemia

10.6320/FJM.2002.6(4).09

葉建宏(Jiann-Horng Yeh)；沈幸梅(Hsing-Mei Shen)；李美芬(May-Fen Lee)；邱浩彰(Hou-Chang Chiu)

雙重過濾血漿分離術 ； 三酸甘油脂 ； 膽固醇 ； 清除率 ； 穿膜壓 ； double-filtration plasmapheresis ； triglyceride ； cholesterol ； removal rate ； transmembrane pressure

台灣醫學

6卷4期（2002 / 07 / 01）

546 - 551

繁體中文

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.

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.