Abstract
Amaç: Kardiyovasküler hastalıklar (KVH) dünya çapında,
mortalite ve morbiditenin majör nedeni olma yolunda gittikçe artan bir rol
üstlenmektedir. Böylesine önemli bir sağlık sorununda, son derece yüksek
maliyetle yürütülebilen tedavi çalışmalarına ek olarak primer ve sekonder
korunma çalışmalarına ağırlık verilmesi gereği açıktır. Dislipidemi, koroner
arter hastalığını (KAH) öngören düzeltilebilir önemli bir risk faktördür.
Dünyada altı adet LDL aferez yöntemi vardır. Fakat daha önce kaskad filtrasyon
yönteminin inflamatuar süreç üzerine etkilerini gösteren geniş kapsamlı bir
çalışma yoktur. Yöntem:
Hiperlipidemik hastalarda düşük yoğunluklu lipoprotein (LDL) aferez yöntemi
olan çift filtrasyon plazmaferezi (DFPP) ve kaskad filtrasyonunun; lipid
profili ve yüksek-duyarlıklı CRP (hs-CRP), üzerine etkilerinin incelenmesi
amaçlı yapılmış olan çalışmamıza kardiyoloji polikliniğine başvurmuş aktif
enfeksiyonu olmayan 12 hiperlipidemik hasta alındı, her hastaya 6 seans olmak
üzere toplam 72 seans aferez uygulandı. Bulgular:
Hiperlipidemik hastalarda aferez sonrası lipid ve hs-CRP değerleri aferez
öncesine göre değerlendirildi. Aferez sonrası değerlendirilen lipid ve hs-CRP
düzeyleri aferez öncesine göre istatistiksel olarak anlamlı düşük bulundu. Sonuç: Bulgularımız, maksimum diyet ve
ilaç tedavisine yanıt alınamayan hiperlipidemik hastalarda lipid aferezinin;
KAH tedavisinde primer ve sekonder korumada LDL kolesterol düzeyini etkin
olarak düşürdüğünden mortalite ve morbiditede etkili olabileceğini
desteklemektedir. Ayrıca azaltılan hs-CRP düzeylerinin aterosklerotik lezyon
için olumlu katkı sağlayacağı düşünülmüştür. Hiperlipidemik hastalarda kaskad
filtrasyon tekniği ile yapılan lipid aferezinin lipid düzeyi ve hs-CRP
üzerindeki etkilerinin klinik sonuçları çalışmamıza göre son derece olumlu gibi
görünse de, daha geniş kapsamlı, uzun süreli ve yüksek hasta sayısı ile yapılan
çalışmalara ihtiyaç vardır.
References
- 1) Chen Z, Peto R, Collins R, et al. Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ 1991; 303: 276–82.
- 2) Management of familial hypercholesterolemia in adult patients: Recommendations from the national lipid association expert panel on familial hypercholesterolemia. Journal of clinical lipidology 2011; 5(5): 3.
- 3) Ross R. The pathogenesis of atherosclerosis a perspective for the 1990s nature. 1993; 362: 801–809.
- 4) Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347:1557–65.
- 5) Stoffel W, Borberg H, Greve V. Application of specific extracorporeal removal of low density lipoprotein in familial hypercholesterolaemia. Lancet 1981; 2: 1005–1007.
- 6) Kron AA, Aengevaeren WRM, van de Werf T, et al. LDL-apheresis atherosclerosis regression study (LAARS), effect of agresive versus conventional lipi lowering tretment on coronary atherosclerosis. Circulatıon 1996; 93: 1826–35.
- 7) Thompson GR. LDL Apheresis Working Group. Recommendation for he use of LDL apheresis. Atherosclerosis 2008; 198:247–55.
- 8) Matsuzaki M, Hiramori K, Imaizumi T, et al. İntravascular ultrasound evaluatıon of coronary plaque regressıon by low density lipoprotein apheresis in familial hypercholesterolemia. J Am Coll Cardiol 2002; 40: 220– 227.
- 9) Mabuchi H, Koizumi J, Shimzu M, et al. Long – term efficacay of lowdensity lipoprotein-aferesis in familial hypercholesterolemia. J Am Coll Cardiol 2002; 40.220–7.
- 10) Kuper H, Nicholson A, Kivimaki M, et al. Evaluating the causal relevance of diverse risk markers: Horizontal systematic review. BMJ 2009; 339: 4265.
- 11) Verma S, Szmitko PE, Yeh ET. C-reactive protein: structure affects function. Circulation 2004;109:1914–7.
- 12) Anand SS, Yusuf S. C-reactive protein is a by stander of cardiovascular disease. Eur Heart J 2010; 31: 2092–6.
- 13) Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359: 2195–207.
- 14) Puntoni M, Sbrana F, Bigazzi F, et al. Myeloperoxidase modulation by LDL apheresis in familial hypercholesterolemia. Lipids Health Dis 2011; 10: 185.
- 15) Kojima S, Shida M, Yokoyama H. Changes in C-reactive protein plasma levels during low-density lipoprotein apheresis. Ther Apher Dial 2003; 7: 431–434.
- 16) Kobayashi S, Moriya H, Maesato K, Okamoto K, Ohtake T. LDLapheresis improves peripheral arterial occlusive disease with an implication for anti-inflammatory effects. J Clin Apher 2005;20: 239
- 17) Kobayashi S, Oka M, Moriya H, et al. LDL-apheresis reduces pselectin, crp and fibrinogen, possible important implications for improving atherosclerosis. Ther Apher Dial 2006;10: 219–23.
- 18) Barbagallo CM, Averna MR, Di Marco T, et al. Effectiveness of cascade filtration plasmapheresis in two patients affected by familial hypercholesterolemia. J Clin Apher 1995;10: 96–100.
- 19) Bramlage CP, VW Armstrong, A Zapf, et all. Low-density lipoprotein apheresis decreases ferritin, transferrin and vitamin B12, which may cause anemia in serially treated patients. Ther Apher Dial. 2010; 14(2):136–42.
- 20) Eisenhauer T, Armstrong VW, Wieland H, et al. Selective removal of low density lipoproteins by precipitation at low pH: first clinical application of the HELP system. Klin Wochenschr 1987;65.161–8.
- 21) Bambuer R, Schiel R, Latza R. Low density lipoprotein apheresis: An overview. Ther Apher Dial 2003; 7: 382–390.
Abstract
References
- 1) Chen Z, Peto R, Collins R, et al. Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ 1991; 303: 276–82.
- 2) Management of familial hypercholesterolemia in adult patients: Recommendations from the national lipid association expert panel on familial hypercholesterolemia. Journal of clinical lipidology 2011; 5(5): 3.
- 3) Ross R. The pathogenesis of atherosclerosis a perspective for the 1990s nature. 1993; 362: 801–809.
- 4) Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347:1557–65.
- 5) Stoffel W, Borberg H, Greve V. Application of specific extracorporeal removal of low density lipoprotein in familial hypercholesterolaemia. Lancet 1981; 2: 1005–1007.
- 6) Kron AA, Aengevaeren WRM, van de Werf T, et al. LDL-apheresis atherosclerosis regression study (LAARS), effect of agresive versus conventional lipi lowering tretment on coronary atherosclerosis. Circulatıon 1996; 93: 1826–35.
- 7) Thompson GR. LDL Apheresis Working Group. Recommendation for he use of LDL apheresis. Atherosclerosis 2008; 198:247–55.
- 8) Matsuzaki M, Hiramori K, Imaizumi T, et al. İntravascular ultrasound evaluatıon of coronary plaque regressıon by low density lipoprotein apheresis in familial hypercholesterolemia. J Am Coll Cardiol 2002; 40: 220– 227.
- 9) Mabuchi H, Koizumi J, Shimzu M, et al. Long – term efficacay of lowdensity lipoprotein-aferesis in familial hypercholesterolemia. J Am Coll Cardiol 2002; 40.220–7.
- 10) Kuper H, Nicholson A, Kivimaki M, et al. Evaluating the causal relevance of diverse risk markers: Horizontal systematic review. BMJ 2009; 339: 4265.
- 11) Verma S, Szmitko PE, Yeh ET. C-reactive protein: structure affects function. Circulation 2004;109:1914–7.
- 12) Anand SS, Yusuf S. C-reactive protein is a by stander of cardiovascular disease. Eur Heart J 2010; 31: 2092–6.
- 13) Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359: 2195–207.
- 14) Puntoni M, Sbrana F, Bigazzi F, et al. Myeloperoxidase modulation by LDL apheresis in familial hypercholesterolemia. Lipids Health Dis 2011; 10: 185.
- 15) Kojima S, Shida M, Yokoyama H. Changes in C-reactive protein plasma levels during low-density lipoprotein apheresis. Ther Apher Dial 2003; 7: 431–434.
- 16) Kobayashi S, Moriya H, Maesato K, Okamoto K, Ohtake T. LDLapheresis improves peripheral arterial occlusive disease with an implication for anti-inflammatory effects. J Clin Apher 2005;20: 239
- 17) Kobayashi S, Oka M, Moriya H, et al. LDL-apheresis reduces pselectin, crp and fibrinogen, possible important implications for improving atherosclerosis. Ther Apher Dial 2006;10: 219–23.
- 18) Barbagallo CM, Averna MR, Di Marco T, et al. Effectiveness of cascade filtration plasmapheresis in two patients affected by familial hypercholesterolemia. J Clin Apher 1995;10: 96–100.
- 19) Bramlage CP, VW Armstrong, A Zapf, et all. Low-density lipoprotein apheresis decreases ferritin, transferrin and vitamin B12, which may cause anemia in serially treated patients. Ther Apher Dial. 2010; 14(2):136–42.
- 20) Eisenhauer T, Armstrong VW, Wieland H, et al. Selective removal of low density lipoproteins by precipitation at low pH: first clinical application of the HELP system. Klin Wochenschr 1987;65.161–8.
- 21) Bambuer R, Schiel R, Latza R. Low density lipoprotein apheresis: An overview. Ther Apher Dial 2003; 7: 382–390.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | April 15, 2018 |
| Submission Date | July 5, 2017 |
| Acceptance Date | October 5, 2017 |
| Published in Issue | Year 2018 Volume: 11 Issue: 1 |
Cite
MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.
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