Alexy Tamas, Detterich Jon, Connes Philippe, Toth Kalman, Nader Elie, Kenyeres Peter, Arriola-Montenegro Jose, Ulker Pinar, Simmonds Michael J
Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, United States.
Department of Pediatrics, Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Front Physiol. 2022 Jul 6;13:906768. doi: 10.3389/fphys.2022.906768. eCollection 2022.
It has been long known that blood health heavily influences optimal physiological function. Abnormalities affecting the physical properties of blood have been implicated in the pathogenesis of various disorders, although the exact mechanistic links between hemorheology and clinical disease manifestations remain poorly understood. Often overlooked in current medical practice, perhaps due to the promises offered in the molecular and genetic era, the physical properties of blood which remain a valuable and definitive indicator of circulatory health and disease. Bridging this gap, the current manuscript provides an introduction to hemorheology. It reviews the properties that dictate bulk and microcirculatory flow by systematically dissecting the biomechanics that determine the non-Newtonian behavior of blood. Specifically, the impact of hematocrit, the mechanical properties and tendency of red blood cells to aggregate, and various plasma factors on blood viscosity will be examined. Subsequently, the manner in which the physical properties of blood influence hemodynamics in health and disease is discussed. Special attention is given to disorders such as sickle cell disease, emphasizing the clinical impact of severely abnormal blood rheology. This review expands into concepts that are highly topical; the relation between mechanical stress and intracellular homeostasis is examined through a contemporary cell-signaling lens. Indeed, accumulating evidence demonstrates that nitric oxide is not only transported by erythrocytes, but is locally produced by mechanically-sensitive enzymes, which appears to have intracellular and potentially extracellular effects. Finally, given the importance of shear forces in the developing field of mechanical circulatory support, we review the role of blood rheology in temporary and durable mechanical circulatory support devices, an increasingly utilized method of life support. This review thus provides a comprehensive overview for interested trainees, scientists, and clinicians.
长期以来，人们一直知道血液健康对最佳生理功能有重大影响。尽管血液流变学与临床疾病表现之间的确切机制联系仍知之甚少，但影响血液物理性质的异常已被认为与各种疾病的发病机制有关。在当前的医学实践中，血液的物理性质常常被忽视，这可能是由于分子和基因时代带来的前景所致，而血液的物理性质仍然是循环系统健康和疾病的重要且决定性指标。为弥合这一差距，本手稿对血液流变学进行了介绍。它通过系统剖析决定血液非牛顿行为的生物力学，回顾了决定总体和微循环血流的特性。具体而言，将研究血细胞比容、红细胞聚集的机械性质和趋势以及各种血浆因子对血液粘度的影响。随后，将讨论血液物理性质在健康和疾病状态下影响血液动力学的方式。特别关注镰状细胞病等疾病，强调严重异常的血液流变学对临床的影响。本综述还扩展到了一些热门概念；通过当代细胞信号转导视角研究了机械应力与细胞内稳态之间的关系。事实上，越来越多的证据表明，一氧化氮不仅由红细胞运输，还由机械敏感酶在局部产生，这似乎具有细胞内和潜在的细胞外作用。最后，鉴于剪切力在机械循环支持这一发展领域中的重要性，我们回顾了血液流变学在临时和持久机械循环支持装置中的作用，这是一种越来越常用的生命支持方法。因此，本综述为感兴趣的实习生、科学家和临床医生提供了全面的概述。
