Evaluation of intravascular hemolysis with erythrocyte creatine

心内高速射流通过狭窄或功能不全的瓣口可引起血管内溶血。已经在人工心脏瓣膜患者和本土瓣膜心脏病患者中发现了血管内溶血。红细胞肌酸被认为是反映红细胞平均年龄的一个敏感的定量指标，因为随着细胞年龄的增长，红细胞中的肌酸含量逐渐降低，而红细胞肌酸的升高定量地反映了红细胞存活的缩短程度。为检测心脏瓣膜置换术和主动脉瓣狭窄患者的血管内溶血反应，用其他溶血标志物和血流动力学参数检测红细胞肌酸。在心脏瓣膜置换术患者中，红细胞肌酸水平(1.8mol.8mol.8molHb)高于红细胞肌酸水平正常者的总峰值流速显著高于红细胞肌酸水平正常者(p=0.006)。红细胞肌酸与总峰值血流速度呈显著正相关(r=0.64p&lt；0.001)。高乳酸脱氢酶水平(460IU/L)患者的肌红蛋白(P=0.008)和肌球蛋白轻链1(P=0.02)显著高于乳酸脱氢酶正常者，而红细胞肌酸与心肌标志物无关。在主动脉狭窄患者中，主动脉狭窄患者红细胞肌酸显著高于对照组(P&lt；0.001)。主动脉瓣狭窄患者的红细胞计数、血红蛋白和红细胞压积均显著低于对照组。16例主动脉瓣狭窄患者中有14例出现峰值流速&50 mm Hg，红细胞肌酸与峰值流速呈正相关(r=0.72p&lt；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。

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.