LDLアフェレシスにおけるフィブリノーゲン除去に関する基礎的研究 : DFPP(DF)サーモ法とデキストラン硫酸(DS)吸着法の比較(<特集>アフェレシスにおけるセイフティーマネジメント)  [in Japanese] Basic Study of Fibrinogen Elimination by Low-Density Lipoprotein (LDL) Apheresis : Comparison of the Double-Filtration Plasmapheresis (DF) Thermo and Dextran Sulfate (DS) Adsorption Methods  [in Japanese]

閉塞性動脈硬化症(ASO)の病因(関連)物質の一つに挙げられているフィブリノーゲンに着目し, 2つのLDLアフェレシス療法(DFサーモ, DS吸着法)における除去特性を比べた.同血漿処理量のcrossover試験の結果, 平均除去率でDFサーモ法49%に対し, DS吸着39%であり, DFサーモ法が優れている結果が得られた.また, 血液回路の各ポイントにて採血し, フィブリノーゲンの除去動態を調べたところ, DFサーモ法は血漿成分分画器膜面上において, フィブリノーゲンを効率よく阻止する結果を示した.DS吸着法は吸着器への血漿灌流初期ほど, 出口側フィブリノーゲン値は低値を示し, 吸着除去が観察されたが, 血漿灌流量の増加とともに徐々に飽和に達した.また, 治療終了後の総廃液中には, 凝固・線溶系の活性化により産生された反応生成物および分解産物の一部が高濃度に検出された.これにより, 以前のフィブリノーゲン非吸着説は否定され, フィブリノーゲンもDS吸着剤に吸着する可能性が示された.

Since fibrinogen is a factor that is thought to cause or be related to arteriosclerosis obliterans (ASO), we compared two LDL apheresis methods (DF Thermo and DS adsorption) in terms of their fibrinogen elimination profile. A crossover study on the same plasma volume revealed that the mean elimination rate by DF Thermo and DS adsorption was 49% and 39%, respectively, suggesting the superiority of the DF Thermo method. The fibrinogen elimination profiles for plasma samples collected from each point of the extracorporeal circuit were also determined. Fibrinogen was efficiently separated by the plasma fractionator membrane of the DF Thermo method. The reduction rate for plasma fibrinogen in the DS adsorption column was more prominent during the initial stage of perfusion but gradually diminished with time as adsorption capacity of the column was saturated. High concentrations of coagulation and fibrinolysis activation products and some degradation products were detected in the waste fluid after adsorption. These results contradict previous reports and suggest the possibility of adsorbing fibrinogen with the DS adsorbent.