Evaluation of intravascular hemolysis with erythrocyte creatine in patients with cardiac valve prostheses
Evaluation of intravascular hemolysis with erythrocyte creatine in patients with cardiac valve prostheses
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DOI：
10.1378/chest.125.6.2115
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发表时间：
2004-06-01
期刊：
影响因子：
9.6
通讯作者：
Sugiura, T
中科院分区：
文献类型：
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作者：
Okumiya, T;Isikawa-Nishi, M;Sugiura, T
研究目的：检测人工心脏瓣膜患者的血管内溶血。红细胞肌酸是红细胞年龄的标志物，随着红细胞存活时间的缩短而增加，与其他溶血标志物和血流动力学参数一起进行评价。设计：前瞻性研究。对33例人工瓣膜置换术患者进行了红细胞肌酸酶法测定，其中主动脉瓣置换术15例，二尖瓣置换术13例，5例双瓣（主动脉瓣和二尖瓣）置换术，33例对照组。多普勒超声心动图测定血流速度和瓣膜返流。其他溶血标记物（乳酸脱氢酶[LDH]、网织红细胞计数和结合珠蛋白）和心肌标记物（肌红蛋白和肌球蛋白轻链1）也被测量。结果：与对照组相比，人工瓣膜患者的红细胞肌酸和LDH水平显著较高（p <0.0001），结合珠蛋白水平较低（p < 0.0001）。然而，这些标记物在有返流（n = 17）和无返流（n = 16）的患者之间无显著差异。红细胞肌酸水平高的患者（> 1.8 mumol/g血红蛋白）的总峰值流速（二尖瓣和主动脉瓣峰值流速之和）显著高于红细胞肌酸水平正常的患者（p = 0.006）。红细胞肌酸与总峰流速有显著相关性（r = 0.64，p < 0.0001），而乳酸脱氢酶和结合珠蛋白与总峰流速无显著相关性。高LDH水平（> 460 IU/L）的患者显示肌红蛋白（p = 0.008）和肌球蛋白轻链1（p = 0.02）显著高于LDH水平正常的患者，而红细胞肌酸与心肌标记物无关。结论：红细胞肌酸是人工瓣膜患者血管内溶血的定量和可靠的标记物。轻度溶血可归因于瓣膜流速而非返流。
Study objectives: To detect intravascular hemolysis in patients with cardiac valve prostheses. Erythrocyte creatine, a marker of erythrocyte age that increases with shortening erythrocyte survival, was evaluated with other hemolytic markers and hemodynamic parameters.Design: Prospective study.Patients and measurements: Erythrocyte creatine was enzymatically assayed in 33 patients with prosthetic valves, including 15 patients with aortic valve replacement, 13 patients with mitral valve replacement, and 5 patients with double-valve (aortic and mitral) replacement, and 33 control subjects. Blood flow velocity and valvular regurgitation were determined by Doppler echocardiography. other hemolytic markers (lactate dehydrogenase [LDH], reticulocyte count, and haptoglobin) and cardiac muscle markers (myoglobin and myosin light chain 1) were also measured.Results: Erythrocyte creatine and LDH levels were significantly higher (p < 0.0001) and the haptoglobin level was lower (p < 0.0001) in patients with a prosthetic valve as compared with control subjects. However, there were no significant differences in these markers between those with (n = 17) and without (n = 16) regurgitation. Patients with high erythrocyte creatine levels (> 1.8 mumol/g hemoglobin) exhibited significantly higher total peak flow velocity (sum of peak flow velocities at mitral and aortic valves) than those with normal erythrocyte creatine levels (p = 0.006). Erythrocyte creatine had a significant correlation with total peak flow velocity (r = 0.64, p < 0.0001), but LDH and haptoglobin had no significant correlation with total peak flow velocity. Patients with high LDH levels (> 460 IU/L) showed significantly higher myoglobin (p = 0.008) and myosin light chain 1 (p = 0.02) than those with normal LDH levels, whereas erythrocyte creatine was not related to cardiac muscle markers.Conclusions: Erythrocyte creatine is a quantitative and reliable marker for intravascular hemolysis in patients with prosthetic valves. Mild hemolysis is ascribable to valvular flow velocity rather than regurgitation.