北京生物医学工程

红细胞比容水平与冠心病发展的相关性研究

The relationship between hematocrit level and thedevelopment of coronary heart disease

作者：曹洪帅李佳松谢佳宏舒丽霞蔺嫦燕

单位：首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所(北京100029),<br />首都医科大学临床生物力学应用基础研究北京市重点实验室(北京100069). <p>通信作者:蔺嫦燕，教授博士研究生导师。E-mail:lIbl@<br />sina.com</p>

关键词：红细胞比容;冠状动脉狭窄;计算流体动力学;冠心病

分类号：R318.01

出版年·卷·期（页码）：2022·41·6（576-582）

摘要：

目的探讨红细胞比容(hematocrit,HCT)与冠心病发展的相关性及可能存在的作用机制方法纳入首都医科大学附属北京安贞医院体检中心体检人员共 2126 名进行统计分析根据 HCT 分组进行倾向评分匹配后总共匹配 126 对,通过二元 ogistic 回归法分析体检人员 HCT 和冠心病的相关性为探究可能存在的作用机制,本文选取一例临床诊断为冠心病的患者的冠状动脉 CTA 影像数据进行维重建,采用计算流体动力学方法对比分析不同 HCT 水平(10% ~60%)的冠状动脉血管壁面剪切力(wall shear stress,WSS)分布。结果临床数据回归分析显示,HCT 与冠心病的发生存在显著正向关系计算流体动力学分析显示 HCT 水平不同,冠状动脉壁面剪切力存在差异。HCT=10%时具有最低的剪切应力,且 HCT 大小与壁面剪切力呈正相关。当HCT>50%时狭窄部位 WSS 为 42 P,可能导致内皮剥脱进一步损伤血管,导致斑块破裂。结论 HCT 与冠心病发展显著相关,可能通过影响冠状动脉血流动力学参与冠心病的发展。提示临床医生关注 HCT 值和心血管危险因素的结合可能有助于临床诊疗.

Objective To investigate the relationship between hematocrit (HCT) and the emergence ofcoronary heart disease,as well as any potential mechanisms involved. Methods A total of 2 126 middle-agedand elderly people in the Physical Examination Center of Beijing Anzhen Hospital,Capital Medical Universitywere included for statistical analysis. A total of 126 pairs were matched by propensity score matching according to HCT grouping. The correlation between HCT andheart disease was analyzed by binary logistic coronary regression.In order to explore the possible mechanism of action, this paper selected the CTA image data of apatient clinically diagnosed as coronary heart disease for three-dimensional reconstruction, and used computational fluid dynamics method to compare and analyze thedistribution of coronary artery wall shear force at different HCT levels ( 10%- 60%).Results Clinical data weresubjected to regression analysis ,which revealed a substantial positive correlation between coronary heart diseaseincidence and HCT. The results of computational fluid dynamics simulation demonstrated that varied HCT levelsresulted in different coronary wall shear forces. The magnitude of HCT was positively connected with the walshear force ,and HCT = 10% has the lowest shear stress. When HCT >50% ,the WSS of the stenosis site was 42Pa,which might lead to endothelial denudation and further damage to the blood vessel, resulting in plaquerupture. Conclusions HCT is strongly associated with the onset of coronary heart disease and may contribute tothis relationship through altering coronary hemodynamics. The combination of the HCT value and cardiovascularrisk factors is advised for doctors to pay attention to as it may aid in clinical diagnosis and treatment.

参考文献：

[1] Alkhamis TM，Alma’atah BM. Evaluation of red blood cellcontribution to platelet activation in the bulk applying red bloodcell--platelet thrombus as a point source model[J].Advances inBioscience and Biotechnology ,2022 ,13( 2): 92-111.

[2]杨倩倩.崔建国,王树娟,等.红细胞比容与老年冠心病患者冠状动脉病变的相关性研究[J].中华老年心脑血管病杂志2017,19(4): 370-373.
Yang QQ, Cui JG , Wang SJ,et al. Correlation between hematocritand coronary artery lesions in elderly patients with coronary heartdisease[ J]. Chinese Journal of Geriatric Heart Brain and VesselDiseases,2017.19(4): 370-373.
[3]王雷.张新宇,杨琳,等.基于指脉的血液黏度无创检测的可行性分析[J].北京生物医学工程,2022,41(1):68-72.
WangL,Zhang XY，Yang L,et al. Feasibility analysis of noninvasive detection of blood viscosity based on finger pulse[ J]Beijing Biomedical Engineering,2022,41(1): 68-72.
[4]Wang X ,Yu D,Wang J, et al. Analysis of coronary artery lesiondegree and related risk factors in patients with coronary heartdisease based on computer-aided diagnosis of coronaryangiography[J]. Computational and Mathematical Methods inMedicine,2021,2021: 2370496.
[5]Zhou Y，Lee C，Wang J. The computational fluid dynamicsanalyses on hemodynamic characteristics in stenosed arteriamodels[J]. Journal of Healthcare Engineering，2018，2018:4312415
[6]周梦琦,顾宁.红细胞比容与气虚血瘀证冠心病相关性临床研究[J].辽宁中医药大学学报,2022,24(1):105-111.
Zhou MO.Gu N. Clinical study on the relationship betweenhematocrit and coronary heart disease with Qi deficiency andblood stasis syndrome[ J]. Journal of Liaoning University ofTraditional Chinese Medicine,2022,24(1): 105-111.
[7]Khader ASM ,Shenoy BS ,Pai R,et al. Effect of increased severityn patient specific stenosis of common carotid artery using CFD-a case study. World Journal of Modelling and Simulation.2011,7(2): 113-122.

[8]Sui B,Gao P,Lin Y,et al. Hemodynamic parameters distributionof upstream ,stenosis center , and downstream sides of plaques incarotid artery with different stenosis: a MRI and CFD study[ J].Acta Radiologica,2015,56(3): 347-354.

[9]Bahrami S ,Norouzi M. Hemodynamic impacts of hematocrit levelby two-way coupled FSI in the left coronary bifurcation [ J].Clinical Hemorheology and Microcirculation, 2020，76 ( 1):9-26.
[10]Lee UY,Kim CI,Chung GH,et al. Hemodynamic changes in thecarotid artery after infusion of normal saline using computationalfluid dynamics[J]. Diagnostics ( Basel) ,2020,10( 7): 473.

[11]Genkel VV , Kuznetcova AS,Shaposhnik Il. Biomechanical forcesand atherosclerosis: from mechanism to diagnosis and treatment[J]. Current Cardiology Reviews,2020,16( 3): 187-197.

[12]Chen A , Basri AAB,lsmail NB , et al. Simulation of mechanicalheart valve dysfunction and the non-newtonianblood modelapproach[ J]. Applied Bionics and Biomechanics, 2022,2022:9612296.
[13]Owen DGSchenkel TShepherd DET,et al.Assessment of surfaceroughness and blood rheology on local coronary haemodynamics :a multi-scale computational fluid dynamics study[ J].

[14]Journal ofthe Royal Society Interface ,2020,17( 169) :20200327.Owen DG ,de Oliveira DC ,Neale EK ,et al. Numerical modellingof blood rheology and platelet activation through a stenosed leftcoronary artery bifurcation[ J]. PLOS One , 2021， 16 ( 11 ) :e0259196.
[15]Sico JJ,Myers LJ,Fenton BJ,et al. Association between admissionhaematocrit and mortality among men with acute ischaemic stroke[J]. Stroke and Vascular Neurology ,2018,3(3): 160-168.

[16]Kishimoto S，Maruhashi T， Kajikawa M, et al. Hematocrit,hemoglobin and red blood cells are associated with vascularfunction and vascular structure in men[J]. Scientific Reports ,2020,10( 1): 11467.
[17]Jeong HR, Shim YS , Lee HS, et al. Hemoglobin and hematocritlevels are positively associated with blood pressure in children andadolescents 10 to 18 years old[ J]. Scientific Reports, 2021,11( 1): 19052.
[18]Monteiro Junior JGM,de Oliveira Cipriano Torres D , Filho DCSHematological parameters as prognostic biomarkers in patientswith cardiovascular diseases[ J]. Current Cardiology Reviews 2019,15(4): 274-282.
[19]Emamian M，Hasanian SM，Tayefi M，et al. Association ofhematocrit with blood pressure and hypertension[ J]. Journal ofClinical Laboratory Analysis ,2017,31( 6): e22124.

[20]Tarantino G,Barrea L,Capone D ,et al. Hematocrit values predictcarotid intimal-media thickness in obese patients with non-alcoholic fatty liver disease: a cross-sectional study[ J]. Frontiersin Endocrinology ( Lausanne) ,2018,9: 203.

[21]Jin YZ, Zheng DH, Duan ZY, et al. Relationship betweenhematocrit level and cardiovascular risk factors in a community-based population [ J]. Journal of Clinical Laboratory Analysis.2015,29(4): 289-293.

服务与反馈：

【文章下载】【加入收藏】

提示：您还未登录，请登录！点此登录