2020 年第 4 期 第 15 卷

缺血性心肌病患者红细胞渗透脆性的变化及意义

Changes and significance of erythrocyte osmotic fragility in patients with ischemic cardiomyopathy

作者：曹煜晴1帕力旦·赛买提2张焕2孙大公2王喜福1

英文作者：Cao Yuqing1 Palidan Saimaiti2 Zhang Huan2 Sun Dagong2 Wang Xifu1

单位：1首都医科大学附属北京安贞医院急诊危重症中心100029；2北京大学医学部基础医学院生理与病理生理学系100191

英文单位：1Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Physiology and Pathophysiology School of Basic Medical Sciences Peking University Health Science Center Beijing 100191 China

关键词：缺血性心肌病；红细胞渗透脆性；临床意义

英文关键词：Ischemiccardiomyopathy;Erythrocyteosmoticfragility;Clinicalsignificance

• 摘要：

• 【摘要】目的    观察缺血性心肌病（ICM）患者红细胞渗透脆性的变化特点，并探讨可能的机制和临床意义。方法    选取2017年8月至2019年8月首都医科大学附属北京安贞医院因ICM就诊的患者80例（ICM组），另取同期30例健康体检者为对照组，检测不同渗透压下红细胞渗透脆性、红细胞膜Na＋-K＋-ATP酶活性、血浆丙二醛和超氧化物歧化酶(SOD)水平。结果    ICM组患者治疗前在多个氯化钠溶液梯度浓度（0.81%、0.72%、0.63%、0.54%、0.45%、0.36%、0.27%、0.18%、0.09%）下的红细胞溶血率明显高于对照组，红细胞渗透脆性明显降低，治疗后ICM组患者的红细胞溶血率明显降低，红细胞渗透脆性改善。ICM组患者治疗前的红细胞膜Na＋-K＋-ATP酶活性明显低于对照组，血浆丙二醛和SOD水平均明显高于对照组(均P＜0.01)；治疗后Na＋-K＋-ATP酶活性明显高于，血浆丙二醛和SOD水平明显低于治疗前［(4.69±0.25) μmol/(mg·min)比(1.38±0.14) μmol/(mg·min)、(5.20±1.92) μmol/L比(42.10±3.81) μmol/L、(18±5) kNU/L比(52±8) kNU/L，均P＜0.01］。结论    ICM患者红细胞渗透脆性较健康人群明显减低，提示红细胞变形性下降，红细胞通过微小血管的能力降低，不利于组织灌注，可能是造成心肌供血不足的原因之一。而造成红细胞渗透脆性降低的原因可能与细胞膜Na＋-K＋-ATP酶活性减低、血浆脂质过氧化增强有关。

• 【Abstract】Objective    To investigate the changes of erythrocyte osmotic fragility in patients with ischemic cardiomyopathy（ICM）, and to explore the possible mechanisms and clinical significances. Methods    Eighty patients with ICM admitted to Beijing Anzhen Hospital, Capital Medical University from August 2017 to August 2019 were enrolled as observation group; 30 healthy volunteers were enrolled as control group. Osmotic fragility of erythrocytes with different osmotic pressures, activity of Na＋-K＋-ATP enzyme on erythrocyte membrane, levels of plasma malonaldehyde(MDA) and superoxide dismutase(SOD) were analyzed. Results    Before treatment, hemolysis rate of erythrocytes in gradient concentrations of sodium chloride solution（0.81%, 0.72%, 0.63%, 0.54%, 0.45%, 0.36%, 0.27%, 0.18%, 0.09%） in the observation group were significantly higher than those in the control group, showing low erythrocyte osmotic fragility in ICM patients; hemolysis rate of erythrocytes decreased and the osmotic fragility were improved after treatment. Activity of Na＋-K＋-ATP enzyme was significantly lower and plasma MDA and SOD levels were higher in the observation group than those in the control group(all P＜0.01); these indexes were significantly improved in the observation group after treatment［(4.69±0.25) μmol/(mg·min) vs (1.38±0.14) μmol/(mg·min)，(5.20±1.92) μmol/L vs (42.10±3.81) μmol/L，(18±5) kNU/L vs (52±8) kNU/L，all P＜0.01］. Conclusions    Osmotic fragility of erythrocytes decreases in ICM patients, indicating poor deformability and ability to pass through microvessels, which inhibits myocardial tissue perfusion and causes cardiac insufficient blood supply. The reason of erythrocyte osmotic fragility reduction may be related to the decrease of Na＋-K＋-ATP enzyme activity and the enhancement of plasma lipid peroxidation.