Evaluation of intravascular hemolysis with erythrocyte creatine

心内高速射流通过狭窄或功能不全的孔口可引起血管内溶血。血管内溶血已在人工心脏瓣膜患者和原生瓣膜性心脏病患者中发现。红细胞肌酸被认为是红细胞平均年龄的一个敏感的定量指标，因为红细胞中肌酸含量随着细胞年龄的增加而逐渐降低，红细胞肌酸的升高定量地反映了红细胞生存时间缩短的程度。为了检测心脏瓣膜假体和主动脉瓣狭窄患者的血管内溶血，我们将红细胞肌酸与其他溶血标志物和血流动力学参数一起评估。在人工心脏瓣膜患者中，高红细胞肌酸水平（血红蛋白1.8μmol/g）患者的总峰值血流速度显著高于正常红细胞肌酸水平（p=0.006）。红细胞肌酸与总峰值流速有显著相关性（r=0.64,p<0.001）。LDH水平高（bb0 460IU/L）患者的肌红蛋白（p=0.008）和肌球蛋白轻链1 （p=0.02）明显高于LDH水平正常的患者，而红细胞肌酸与心肌标志物无关。在主动脉瓣狭窄患者中，与对照组相比，主动脉瓣狭窄患者的红细胞肌酸显著升高（p<0.001）。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例血流峰值为bbb50 mmhg，红细胞肌酸与血流峰值有良好的相关性（r=0.72,p<0.001）。结论：红细胞肌酸是评估人工心脏瓣膜和主动脉瓣狭窄患者血管内溶血严重程度的可靠指标。

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.