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Extracorporeal LDL-cholesterol elimination and platelet volume
Nutrition 29 (2013) 1434–1436
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
Selected abstracts
Selected abstracts from the 29th Congress of the Czech Society for Clinical Nutrition and Intensive Metabolic Care “Nutrition and Regeneration: Perfecting nutrition as the means for health improvement” Hradec Kralove, Czech Republic, March 7–9, 2013 Edited by Vladimir Palicka M.D., Ph.D. EXTRACORPOREAL LDL-CHOLESTEROL ELIMINATION AND PLATELET VOLUME
DYNAMICS OF BLOOD COUNT AFTER RHEOHEMAPHERESIS POSSIBLE ASSOCIATION WITH CLINICAL CHANGES
M. Blaha, M. Kostal, M. Lanska, V. Blaha, J. Maly Charles University in Prague, Medical Faculty and University Hospital in Hradec Kralove, CZ
M. Blaha, M. Kostal, E. Rencova, H. Langrova, J. Studnicka, M. Lanska, V. Blaha, P. Rozsival Charles University in Prague, Medical Faculty and University Hospital in Hradec Kralove, CZ
Introduction: In the recent years increasing attention has been paid to the marker mean platelet volume (MPV). Great attention has also been given to MPV and atheromatosis complications in ischemic heart disease, vascular brain affections, metabolic syndrome and others. The aim of this study was to attract attention to this routinely available, but often disregarded parameter in the context of extracorporeal LDL-cholesterol elimination. Patients and methods: We have a group of 12 long-term treated patients, 7 men and 5 women. The average age is 4716.6 years (range 21-63), median 52 years). The clinical phenotype of familial hypercholesterolemia (FH) is characterized by increased plasma levels of total cholesterol, LDL-cholesterol, tendinous xanthomata, and premature symptoms of coronary heart disease. DNA-based evidence of a mutation in the low-density lipoprotein receptor gene was the criterium for homozygous FH. None of the patients had a mutation in Apo-B gene. All patients are treated with high-dose statins (simvastatin 40 mg or atorvastatin 40-80 mg daily), 1 patient in combination with fenofibrate (200 mg daily), 2 patients in combination with biliary acid-binding resins (6 mg daily), and 10 patients in combination with ezetimibe (10 mg daily). The patients have been regularly treated with LDLapheresis (immunoadsorption) or rheohemapheresis (cascade filtration) for 3-12 years (average 7.2 2.96 years, range 2-11.5, median 7.25). Results: MPV before the procedures was 10.891 fl, CI 10.25-11.53. MPV after the procedures decreased - 10.478 fl, CI 09.84-11.11. The difference is statistically significant (p ¼ 0.036). MPV did not correlate with age, sex, platelet count, and duration of therapy. At the same time, we used rheohemapheresis in the therapy of 40 patients with age-related macular degeneration. But MPV was not changed. Conclusion: MPV is easily available and is often disregarded, and sometimes may suggest the need for a careful assessment in patients with familial hypercholesterolemia. MPV could be one of the markers of therapeutic efficacy in patients with familial hypercholesterolemia treated by extracorporeal LDL-cholesterol elimination that is simple and inexpensive. Acknowledgments: The study was supported by the Grant Agency of the Charles University, Prague, GAUK 373611.
0899-9007/$ - see front matter Ó 2013 Published by Elsevier Inc..
Introduction: Age-related macular degeneration (AMD) is the main cause of legal blindness among the elderly. During the course of AMD periods of long-term stabilization may occur as well as a sudden turn for the worse. Therefore, it is necessary to recognize the disease activity in time and try to stop its progress by rheohemapheresis (RHF). Aim: To identify the blood count changes that could serve as easily available markers of the rheological therapy effectiveness in patients with AMD. Patients: 46 patients included in this study were suffering from the dry form of age-related macular degeneration: 17 men, and 29 women, mean age 68.9 (7.2) years, range: 53-86. The patients had to have diagnosis of AMD in both eyes, dry AMD in one or both eyes confirmed by fluorescein angiography and fundus photography. Controls were recruited from healthy blood donors – 20 men and 50 women mean age 41 10.3 years, range: 19-61 years. Results: Rheopheresis caused a decrease in hemoglobin (p<0.001), leukocytes (p<0.034) and increase in platelets (p<0.005). We identified the platelet/MPV ratio as a good predictor of the clinical outcome. To evaluate clinical effect (changes in the size of the DPED area before and after the treatment) we used platelet/MPV ratio. Using ROC analysis for prediction of favorable prognosis we identified criterion 21.5 (p<0.001), sensitivity 76.9%, specificity 80.0%, AUC 0.817. Patients with platelet/ MPV ratio above 21.5 before the last RHF had significantly better outcome (p¼ 0.003, mean regression in the DPED area was 3.35 mm2 (2.88) vs. 0.344mm2 (2.63)). Conclusion: Basic parameters of blood count significantly change during rheohemaphereses. These changes are not clinically dangerous but in the research may be of high statistical significance. The changes occur after individual RHF procedures (see above) but also during longterm follow-up due to changes in microenvironment. The ratio thrombocyte count/MPV at the end of rheophereses is a possible laboratory marker of the patient’s prognosis. Aknowledgment: The work was supported by the research task of Ministry of Health, CZ: IGA NT 14035-3/2013, DRO (UHHK, 00179906) and PRVOUK P37/12.
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
Selected abstracts
Selected abstracts from the 29th Congress of the Czech Society for Clinical Nutrition and Intensive Metabolic Care “Nutrition and Regeneration: Perfecting nutrition as the means for health improvement” Hradec Kralove, Czech Republic, March 7–9, 2013 Edited by Vladimir Palicka M.D., Ph.D. EXTRACORPOREAL LDL-CHOLESTEROL ELIMINATION AND PLATELET VOLUME
DYNAMICS OF BLOOD COUNT AFTER RHEOHEMAPHERESIS POSSIBLE ASSOCIATION WITH CLINICAL CHANGES
M. Blaha, M. Kostal, M. Lanska, V. Blaha, J. Maly Charles University in Prague, Medical Faculty and University Hospital in Hradec Kralove, CZ
M. Blaha, M. Kostal, E. Rencova, H. Langrova, J. Studnicka, M. Lanska, V. Blaha, P. Rozsival Charles University in Prague, Medical Faculty and University Hospital in Hradec Kralove, CZ
Introduction: In the recent years increasing attention has been paid to the marker mean platelet volume (MPV). Great attention has also been given to MPV and atheromatosis complications in ischemic heart disease, vascular brain affections, metabolic syndrome and others. The aim of this study was to attract attention to this routinely available, but often disregarded parameter in the context of extracorporeal LDL-cholesterol elimination. Patients and methods: We have a group of 12 long-term treated patients, 7 men and 5 women. The average age is 4716.6 years (range 21-63), median 52 years). The clinical phenotype of familial hypercholesterolemia (FH) is characterized by increased plasma levels of total cholesterol, LDL-cholesterol, tendinous xanthomata, and premature symptoms of coronary heart disease. DNA-based evidence of a mutation in the low-density lipoprotein receptor gene was the criterium for homozygous FH. None of the patients had a mutation in Apo-B gene. All patients are treated with high-dose statins (simvastatin 40 mg or atorvastatin 40-80 mg daily), 1 patient in combination with fenofibrate (200 mg daily), 2 patients in combination with biliary acid-binding resins (6 mg daily), and 10 patients in combination with ezetimibe (10 mg daily). The patients have been regularly treated with LDLapheresis (immunoadsorption) or rheohemapheresis (cascade filtration) for 3-12 years (average 7.2 2.96 years, range 2-11.5, median 7.25). Results: MPV before the procedures was 10.891 fl, CI 10.25-11.53. MPV after the procedures decreased - 10.478 fl, CI 09.84-11.11. The difference is statistically significant (p ¼ 0.036). MPV did not correlate with age, sex, platelet count, and duration of therapy. At the same time, we used rheohemapheresis in the therapy of 40 patients with age-related macular degeneration. But MPV was not changed. Conclusion: MPV is easily available and is often disregarded, and sometimes may suggest the need for a careful assessment in patients with familial hypercholesterolemia. MPV could be one of the markers of therapeutic efficacy in patients with familial hypercholesterolemia treated by extracorporeal LDL-cholesterol elimination that is simple and inexpensive. Acknowledgments: The study was supported by the Grant Agency of the Charles University, Prague, GAUK 373611.
0899-9007/$ - see front matter Ó 2013 Published by Elsevier Inc..
Introduction: Age-related macular degeneration (AMD) is the main cause of legal blindness among the elderly. During the course of AMD periods of long-term stabilization may occur as well as a sudden turn for the worse. Therefore, it is necessary to recognize the disease activity in time and try to stop its progress by rheohemapheresis (RHF). Aim: To identify the blood count changes that could serve as easily available markers of the rheological therapy effectiveness in patients with AMD. Patients: 46 patients included in this study were suffering from the dry form of age-related macular degeneration: 17 men, and 29 women, mean age 68.9 (7.2) years, range: 53-86. The patients had to have diagnosis of AMD in both eyes, dry AMD in one or both eyes confirmed by fluorescein angiography and fundus photography. Controls were recruited from healthy blood donors – 20 men and 50 women mean age 41 10.3 years, range: 19-61 years. Results: Rheopheresis caused a decrease in hemoglobin (p<0.001), leukocytes (p<0.034) and increase in platelets (p<0.005). We identified the platelet/MPV ratio as a good predictor of the clinical outcome. To evaluate clinical effect (changes in the size of the DPED area before and after the treatment) we used platelet/MPV ratio. Using ROC analysis for prediction of favorable prognosis we identified criterion 21.5 (p<0.001), sensitivity 76.9%, specificity 80.0%, AUC 0.817. Patients with platelet/ MPV ratio above 21.5 before the last RHF had significantly better outcome (p¼ 0.003, mean regression in the DPED area was 3.35 mm2 (2.88) vs. 0.344mm2 (2.63)). Conclusion: Basic parameters of blood count significantly change during rheohemaphereses. These changes are not clinically dangerous but in the research may be of high statistical significance. The changes occur after individual RHF procedures (see above) but also during longterm follow-up due to changes in microenvironment. The ratio thrombocyte count/MPV at the end of rheophereses is a possible laboratory marker of the patient’s prognosis. Aknowledgment: The work was supported by the research task of Ministry of Health, CZ: IGA NT 14035-3/2013, DRO (UHHK, 00179906) and PRVOUK P37/12.