維持血液透析患者に対するLDLアフェレシスの効果 : 閉塞性動脈硬化症を合併した糖尿病性腎症に対して  [in Japanese] The Effect of Low-Density-Lipoprotein (LDL) Apheresis on Patients Treated with Hemodialysis : The Influence in Diabetic Nephropathy with Arteriosclerosis Obliterans  [in Japanese]

Abstract

近年,血液透析患者にも閉塞性動脈硬化症(ASO)の合併が多くなっている.LDLアフェレシス(LDL-A)は,ASO患者に治療として行われてきたが,その作用機序については議論の点が多い.今回,糖尿病性腎症による血液透析患者57名に対しLDL-A10回施行し,血液検査・臨床症状の変化を検討した.LDL-Aにより脂質は減少,HGF・ブラジキニン・NOは増加した.LDL-A終了3ヵ月後にも,間欠性跂行・歩行距離など臨床症状に効果を認めていた症例では,LDL-A開始前LDL-C88.7mg/dl(無効例100.5mg/dl),Lp(a)31.6mg/dl(無効例40.2mg/dl),NO52.3μmol/L(無効例113.1μmol/L)と低く,NO増加率は,19.1%(無効例1.7%)と大きかった.またLDL-A無効例には,API・PTHが高値で動脈硬化が重度である症例が多く含まれていた.LDL-Aの効果として,脂質減少,ブラジキニン・NO産生などによる血管拡張が考えられた.また血管内膜の障害が軽度である症例に対する効果が大きいものと思われた.

Recently, low-density-lipoprotein (LDL) apheresis has been applied to patients with arteriosclerosis obliterans (ASO). Using this method, we treated 57 diabetic patients with ASO who has been treated using hemodialysis and evaluated the effects of LDL apheresis. At 3 months after 10 cycles of LDL apheresis, many symptoms for such as intermittent claudication and walking distance improved for 32 diabetic patients. The level of serum cholesterol, LDL cholesterol, triglycerides and/or lipoproteins (a) (Lp (a)) was significantly reduced in all patients. On the other hand, the values of plasma bradykinin, serum nitric oxide (NO) and/or hepatocyte growth factor (HGF) increased. LDL cholesterol, Lp (a) and NO levels before treatment with LDL apheresis were significantly lower in patients with positive reactions to LDL apheresis as compared to patients where treatment was ineffective (88.7±7.1 vs. 100.5±6.9 mg/dl, P<0.02; 31.6±4.2 vs. 40.2±2.6mg/dl, p<0.01; 52.3±5.8vs. 113.1±29.1 μmol/L, p<0.01 respectively). Additionally, the increase in NO level after LDL apheresis was significantly larger in the patients with a positive reaction (19.1±2.5 vs. 1.7±0.5%, p<0.01). In patients where treatment was ineffective, the PTH level was higher and duration of hemodialysis was longer. Therefore we assumed that their atherosclerosis and endothelial injuries were more serious. We concluded that LDL apheresis induced the production of bradykinin, NO and HGF, and caused an improvement of microcirculation in peripheral extremities. These changes are more evident in patients with milder vascular endothelial injuries.

Journal

Japanese journal of apheresis   [List of Volumes]

Japanese journal of apheresis 22(1), 64-69, 2003-02-28  [Table of Contents]

Japanese Society for Apheresis

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Codes

  • NII Article ID (NAID) :
    110003144486
  • NII NACSIS-CAT ID (NCID) :
    AA11604174
  • Text Lang :
    JPN
  • ISSN :
    13405888
  • Databases :
    NII-ELS 

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