Odashiro Keita, Maruyama Toru, Yokoyama Taku, Nakamura Hisataka, Fukata Mitsuhiro, Yasuda Shioto, Saito Kazuyuki, Fujino Takehiko, Akashi Koichi
Department of Medicine, and.
Faculty of Art and Science, Kyushu University.
J Atr Fibrillation. 2013 Oct 31;6(3):939. doi: 10.4022/jafib.939. eCollection 2013 Oct-Nov.
Although coronary risk factors promote the formation of atherosclerotic plaque containing activated platelets and inflammatory leukocytes, and play a pivotal role in the development of coronary artery diseases (CAD), the hemorheological effects of these risk factors on circulating intact erythrocytes, a major component of whole blood cells, are poorly understood. Therefore, this study aimed to quantify erythrocyte deformability in patients with coronary risk factors, and enrolled 320 consecutive cardiac outpatients including 33 patients with nonvalvular atrial fibrillation (AF). Patients with acute coronary syndrome or valvular AF were excluded. Demographic variables obtained by medical records were correlated with erythrocyte deformability investigated by our highly sensitive and reproducible filtration technique. Among demographic variables, triglyceride (p = 0.004), HbA1c (p = 0.014) and body weight (p = 0.020) showed significant inverse correlation to the erythrocyte deformability. This deformability was not associated with types of CAD (old myocardial infarction vs. stable angina) or modality of treatment (percutaneous intervention vs. coronary artery bypass grafting). Unexpectedly, stepwise multiple regression analysis demonstrated that nonvalvular AF was the most significant contributor to the impaired erythrocyte deformability (p = 0.002). Hypertension and dyslipidemia are more prevalent in the AF patients (p < 0.001), and the erythrocyte deformability was found to be impaired synergistically and significantly (p < 0.001) during the stepwise accumulation of the coronary risk factors in addition to AF. In conclusion coronary risk factors synergistically impair the erythrocyte deformability, which may play an important role in critically stenotic coronary arteries. Since the impairment of intact erythrocyte deformability is mostly associated with nonvalvular AF, this common arrhythmia may reflect the coronary risk accumulation.
尽管冠状动脉危险因素会促进含有活化血小板和炎性白细胞的动脉粥样硬化斑块形成，并在冠状动脉疾病（CAD）的发展中起关键作用，但这些危险因素对循环中的完整红细胞（全血细胞的主要成分）的血液流变学影响却知之甚少。因此，本研究旨在量化具有冠状动脉危险因素患者的红细胞变形性，并纳入了320例连续的心脏门诊患者，其中包括33例非瓣膜性心房颤动（AF）患者。排除急性冠状动脉综合征或瓣膜性AF患者。通过病历获得的人口统计学变量与通过我们高度敏感且可重复的过滤技术研究的红细胞变形性相关。在人口统计学变量中，甘油三酯（p = 0.004）、糖化血红蛋白（HbA1c）（p = 0.014）和体重（p = 0.020）与红细胞变形性呈显著负相关。这种变形性与CAD类型（陈旧性心肌梗死与稳定型心绞痛）或治疗方式（经皮介入治疗与冠状动脉旁路移植术）无关。出乎意料的是，逐步多元回归分析表明，非瓣膜性AF是红细胞变形性受损的最主要因素（p = 0.002）。高血压和血脂异常在AF患者中更为普遍（p < 0.001），并且除AF外，在冠状动脉危险因素逐步累积过程中，发现红细胞变形性受到协同且显著的损害（p < 0.001）。总之，冠状动脉危险因素协同损害红细胞变形性，这可能在严重狭窄的冠状动脉中起重要作用。由于完整红细胞变形性受损主要与非瓣膜性AF相关，这种常见的心律失常可能反映了冠状动脉风险的累积。
