高脂血症之雙重過濾血漿分離療法

Double-filtration Plasmapheresis in Hyperlipidemia

近年來國外學者以規律地血漿分離療法治療嚴重高脂血症之經驗中，除可以有效降低血中低密度脂蛋白膽固醇，臨床上也同時發現血管硬化斑塊退縮及心電圖缺血進步之現象。本文針對七位嚴重高脂血症男性病人，以雙重過濾血漿分離療法治療，在施行單次治療後血液學上的變化，加以比較其中相關變化。三酸甘油脂之平均清除率最高達53.8%，其次為總膽固醇39.9%及球蛋白21.4%，白蛋白、高密度脂蛋白膽固酵及血小板沒有明顯的變化，白血球治療後不降反升。6例病人因脂血症，無法測出LDL膽固醇的數值。穿膜壓部分，本研究之7例中6例在雙重過濾血漿分離療法進行至一半左右，穿膜壓已超過理想值(50mmHg)。5例穿膜壓>130mmHg，其中2例溶血，1例更換血漿分離器。相對地，全部7例的血漿成份分離器壓力皆維持在正常範圍。本研究中脂質清除效率略低於文獻中報告。可能與以三酸甘油脂升高為主之脂蛋白（非常低密度脂蛋白或乳糜小滴）濃度過高有關，使血漿分離器短時間即飽和，無法再有效地過濾血漿，以致直接影響分離器之效能。因此，在治療以三酸甘油脂升高為主的高脂血症中，如有明顯之脂血現象，則應先以離心法進行血球／血漿分離，避免過濾孔堵塞現象，之後再輔以孔徑較小之血漿成份分離器，以期除去血中較大量的脂質。

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.