Which side of the balance determines the frequency of vaso-occlusive crises in children with sickle cell anemia: Blood viscosity or microvascular dysfunction?
Which side of the balance determines the frequency of vaso-occlusive crises in children with sickle cell anemia: Blood viscosity or microvascular dysfunction?
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DOI：
10.1016/j.bcmd.2015.10.005
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Connes, Philippe
中科院分区：
文献类型：
--
作者：
Charlot, Keyne;Romana, Marc;Connes, Philippe
血管阻力和组织灌注都可能受到血管功能受损和血液粘度增加的影响。血管功能对镰状细胞性贫血（SCA）儿童疼痛性血管闭塞危象（VOC）发生的影响知之甚少。本研究的目的是确定哪一侧的平衡（血液粘度或血管功能）是最有害的SCA，并增加了频繁住院VOC的风险。微血管功能，微循环氧合和血液粘度测定在一组22 SCA儿童/青少年在稳态和一组13名健康儿童/青少年。单变量分析表明，与对照组相比，SCA儿童在局部热加热试验期间的微血管反应性减弱，微循环氧合降低。多因素分析显示，血液粘度升高和微循环氧合降低是SCA患者频繁发生VOC的独立危险因素。相反，微血管功能障碍的水平不能预测VOC的发生率。总之，在血管功能未受损的健康个体中，血液粘度增加通常得到很好的支持。然而，在SCA的背景下，微血管功能受损，血液粘度的任何增加或微循环氧合的减少都会增加频繁VOC的风险。(C)© 2015 Elsevier Inc版权所有。
Vascular resistance and tissue perfusion may be both affected by impaired vascular function and increased blood viscosity. Little is known about the effects of vascular function on the occurrence of painful vaso-occlusive crises (VOC) in children with sickle cell anemia (SCA). The aim of the present study was to determine which side of the balance (blood viscosity or vascular function) is the most deleterious in SCA and increases the risk for frequent hospitalized VOC. Microvascular function, microcirculatory oxygenation and blood viscosity were determined in a group of 22 SCA children/adolescents at steady state and a group of 13 healthy children/adolescents. Univariate analyses demonstrated blunted microvascular reactivity during local thermal heating test and decreased microcirculatory oxygenation in SCA children compared to controls. Multivariate analysis revealed that increased blood viscosity and decreased microcirculatory oxygenation were independent risk factors of frequent VOC in SCA. In contrast, the level of microvascular dysfunction does not predict VOC rate. In conclusion, increased blood viscosity is usually well supported in healthy individuals where vascular function is not impaired. However, in the context of SCA, microvascular function is impaired and any increase of blood viscosity or decrease in microcirculatory oxygenation would increase the risks for frequent VOC. (C) 2015 Elsevier Inc All rights reserved.