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Evaluation of intravascular hemolysis with erythrocyte creatine

红细胞肌酸评价血管内溶血

基本信息

批准号：
16590460
负责人：
SUGIURA Tetsuro
金额：
$ 1.92万
依托单位：
Kochi University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2006
项目状态：
已结题

项目摘要

Intracardiac high-velocity jets through stenosed or incompetent orifices can cause intravascular hemolysis. Intravascular hemolysis has been identified in patients with prosthetic heart valves and in patients with native valvular heart disease. Erythrocyte creatine is regarded as a sensitive and quantitative marker of mean age of the erythrocytes, because creatine contents in erythrocytes decrease gradually with advancing cell age and an increase in erythrocyte creatine quantitatively reflects the degree of shortened erythrocyte survival. To detect intravascular hemolysis in patients with cardiac valve prostheses and aortic stenosis, erythrocyte creatine was evaluated with other hemolytic markers and hemodynamic parameters.In patients with prosthetic heart valves, those with high erythrocyte creatine levels (>1.8μmol/g hemoglobin) exhibited significantly higher total peak flow velocity 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<0.001). Patients with high LDH levels (>460IU/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.In patients with aortic stenosis, patients with aortic stenosis had a significantly higher erythrocyte creatine as compared with the controls (p<0.001). Patients with aortic stenosis had significantly lower erythrocyte count, hemoglobin and hematocrit than those in controls. Fourteen of 16 patients with aortic stenosis had peak flow velocity >50mmHg and erythrocyte creatine had a good correlation with peak flow velocity (r=0.72,p<0.001).Conclusion : Erythrocyte creatine is a reliable marker to estimate the severity of intravascular hemolysis in patients with prosthetic heart valve and aortic stenosis.

通过狭窄或功能不全的孔口的心内高速射流可引起血管内溶血。在人工心脏瓣膜患者和自体心脏瓣膜病患者中已发现血管内溶血。红细胞肌酸被认为是红细胞平均年龄的敏感和定量标志物，因为红细胞中肌酸含量随着细胞年龄的增加而逐渐减少，红细胞肌酸的增加定量地反映了红细胞存活缩短的程度。为了检测人工心脏瓣膜和主动脉瓣狭窄患者的血管内溶血，红细胞肌酸与其他溶血标志物和血流动力学参数进行了评价。在人工心脏瓣膜患者中，红细胞肌酸水平高（>1.8μmol/g血红蛋白）的患者的总峰值流速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呈显著正相关（r= 0.64，P <0.001）。LDH水平高（> 460 IU/L）的患者肌红蛋白（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志物无关。主动脉瓣狭窄患者红细胞计数、血红蛋白和红细胞压积明显低于对照组。16例主动脉瓣狭窄患者中有14例峰值血流速度> 50 mmHg，红细胞肌酸与峰值血流速度有良好的相关性（r= 0.72，p <0.001），结论：红细胞肌酸是判断主动脉瓣狭窄患者血管内溶血严重程度的可靠指标。