北京生物醫(yī)學(xué)工程

紅細(xì)胞比容水平與冠心病發(fā)展的相關(guān)性研究

The relationship between hematocrit level and thedevelopment of coronary heart disease

作者：曹洪帥李佳松謝佳宏舒麗霞藺嫦燕

單位：首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院-北京市心肺血管疾病研究所(北京100029),<br />首都醫(yī)科大學(xué)臨床生物力學(xué)應(yīng)用基礎(chǔ)研究北京市重點(diǎn)實(shí)驗(yàn)室(北京100069). <p>通信作者:藺嫦燕，教授博士研究生導(dǎo)師。E-mail:lIbl@<br />sina.com</p>

關(guān)鍵詞：紅細(xì)胞比容;冠狀動(dòng)脈狹窄;計(jì)算流體動(dòng)力學(xué);冠心病

分類(lèi)號(hào)：R318.01

出版年·卷·期（頁(yè)碼）：2022·41·6（576-582）

摘要：

目的探討紅細(xì)胞比容(hematocrit,HCT)與冠心病發(fā)展的相關(guān)性及可能存在的作用機(jī)制方法納入首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院體檢中心體檢人員共 2126 名進(jìn)行統(tǒng)計(jì)分析根據(jù) HCT 分組進(jìn)行傾向評(píng)分匹配后總共匹配 126 對(duì),通過(guò)二元 ogistic 回歸法分析體檢人員 HCT 和冠心病的相關(guān)性為探究可能存在的作用機(jī)制,本文選取一例臨床診斷為冠心病的患者的冠狀動(dòng)脈 CTA 影像數(shù)據(jù)進(jìn)行維重建,采用計(jì)算流體動(dòng)力學(xué)方法對(duì)比分析不同 HCT 水平(10% ~60%)的冠狀動(dòng)脈血管壁面剪切力(wall shear stress,WSS)分布。結(jié)果臨床數(shù)據(jù)回歸分析顯示,HCT 與冠心病的發(fā)生存在顯著正向關(guān)系計(jì)算流體動(dòng)力學(xué)分析顯示 HCT 水平不同,冠狀動(dòng)脈壁面剪切力存在差異。HCT=10%時(shí)具有最低的剪切應(yīng)力,且 HCT 大小與壁面剪切力呈正相關(guān)。當(dāng)HCT>50%時(shí)狹窄部位 WSS 為 42 P,可能導(dǎo)致內(nèi)皮剝脫進(jìn)一步損傷血管,導(dǎo)致斑塊破裂。結(jié)論 HCT 與冠心病發(fā)展顯著相關(guān),可能通過(guò)影響冠狀動(dòng)脈血流動(dòng)力學(xué)參與冠心病的發(fā)展。提示臨床醫(yī)生關(guān)注 HCT 值和心血管危險(xiǎn)因素的結(jié)合可能有助于臨床診療.

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.

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