Koppensteiner R, Moritz A, Schlick W, Fenzl G, Roedler S, Ehringer H, Wollner E
Department of Medicine, University of Vienna, Austria.
Am J Cardiol. 1991 Jan 1;67(1):79-83. doi: 10.1016/0002-9149(91)90104-s.
Arterial thromboembolism is a serious complication in patients after heart valve replacement. Abnormalities in blood rheology may contribute to this complication. Therefore, the aim of this study was to compare various determinants of blood rheology in patients with substitute heart valves with those in healthy controls; furthermore, differences between patients with mechanical valves and those with bioprostheses should be investigated. The hemorrheologic determinants--fibrinogen, plasma viscosity, red cell aggregation, hematocrit and platelet aggregation--were studied in 92 patients with mechanical bileaflet valves, in 28 patients with bioprostheses and in 29 control subjects; the time since valve replacement was greater than or equal to 9 months. Fibrinogen, plasma viscosity, red cell and spontaneous platelet aggregation were found to be increased in all patients after heart valve replacement compared with normal subjects (fibrinogen: 348 +/- 87 vs 267 +/- 66 mg/dl, p less than 0.01; plasma viscosity: 1.71 +/- 0.1 vs 1.66 +/- 0.1 mPas, p less than 0.05; red cell aggregation: 9.9 +/- 2 vs 7.8 +/- 2 U, p less than 0.01; platelet aggregation: 22 +/- 15 vs 13 +/- 13%, p less than 0.01); among patients, fibrinogen, plasma viscosity and spontaneous platelet aggregation were higher in mechanical valves than in bioprostheses (fibrinogen: 359 +/- 95 vs 314 +/- 41 mg/dl, p less than 0.01; plasma viscosity: 1.72 +/- 0.1 vs 1.68 +/- 0.1 mPas, p less than 0.1; platelet aggregation: 23 +/- 15 vs 16 +/- 11%; p less than 0.05), whereas no difference could be found for red cell aggregation (9.7 +/- 2 vs 10.5 +/- 2%, p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
动脉血栓栓塞是心脏瓣膜置换术后患者的一种严重并发症。血液流变学异常可能导致这一并发症。因此，本研究的目的是比较心脏瓣膜置换患者与健康对照者血液流变学的各种决定因素；此外，还应研究机械瓣膜患者与生物瓣膜患者之间的差异。对92例接受双叶机械瓣膜置换、28例接受生物瓣膜置换的患者以及29例对照者进行了血液流变学决定因素——纤维蛋白原、血浆粘度、红细胞聚集、血细胞比容和血小板聚集的研究；瓣膜置换术后时间均大于或等于9个月。结果发现，与正常受试者相比，所有心脏瓣膜置换术后患者的纤维蛋白原、血浆粘度、红细胞和自发性血小板聚集均增加（纤维蛋白原：348±87 vs 267±66 mg/dl，p＜0.01；血浆粘度：1.71±0.1 vs 1.66±0.1 mPas，p＜0.05；红细胞聚集：9.9±2 vs 7.8±2 U，p＜0.01；血小板聚集：22±15 vs 13±13%，p＜0.01）；在患者中，机械瓣膜患者的纤维蛋白原、血浆粘度和自发性血小板聚集高于生物瓣膜患者（纤维蛋白原：359±95 vs 314±41 mg/dl，p＜0.01；血浆粘度：1.72±0.1 vs 1.68±0.1 mPas，p＜0.1；血小板聚集：23±15 vs 16±11%；p＜0.05），而红细胞聚集无差异（9.7±2 vs 10.5±2%，p＞0.05）。（摘要截选至250字）
