状細胞病における低血圧症:バイオマーカーの調節と病理生理学における関連性
B N Yamaja Setty1, Marie J Stuart, Carlton Dampier
1Department of Pediatrics and the Marian Anderson Sickle Cell Center Core Laboratory, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Lancet (London, England)
|November 7, 2003
まとめ
状細胞疾患の小児における夜間オキシヘモグロビン不飽和は,細胞の粘着と活性化の増加と関連しています. これは,血管閉塞の危機と潜在的な脳卒中リスク要因のメカニズムを示唆しています.
科学分野:
- 血液学 ヘマトロジ
- 小児科は小児科です.
- 心血管科学 心血管科学
背景:
- 夜間オキシヘモグロビン不飽和は,中枢神経系 (CNS) の合併症と状細胞疾患 (SCD) の痛ましい危機に寄与する可能性があります.
- オキシヘモグロビン不飽和症の生物学的関係と血液学的危険因子を調査することは,SCDの病理生理学を理解するために重要である.
研究 の 目的:
- SCDの子どもにおけるオキシヘモグロビン不飽和と血液学的危険因子の間の生物学的な関係を調べる.
- SCDの小児の睡眠中の細胞活性化マーカーと酸素飽和度の関連を記述する.
主な方法:
- 溶解性血管細胞粘着分子1 (P-セレクチン,L-セレクチン,およびルオコトリエンB4) を用いて細胞活性化を評価した.
- 赤血球-内皮粘着,通常の血液学的変数,およびパルス酸素測定による酸素飽和度 (SaO2) を覚醒および眠っている子供で測定した.
- 子どもは4つのグループに分けられた:コントロール,HbSC (ノーマキシック),HbSS (ノーマキシック),HbSS (ヒポキシック,平均睡眠時間SaO2 <または=93%).
主要な成果:
- 睡眠中のSaO2は,詰まった細胞容量 (r=0.7;p<0.0001) と有意な相関関係を示した.
- 睡眠中のSaO2と細胞粘着,白血球,血小板,内皮活性化のマーカー (p<0.01) の間には逆の関係が見られた.
- HbSSと睡眠中の低酸素症を持つ子どもは,覚醒している間も継続的な低酸素症を示しており,SaO2と細胞活性化マーカーとの間には同様の相関関係がある.
結論:
- この発見は,オキシヘモグロビン不飽和を,粘着関連の経路を通じて,SCDにおける血管閉塞性危機の増加と結びつける潜在的なメカニズムを示唆しています.
- 細胞媒介体放出と貧血を含む低酸素媒介経路は,SCDにおける中枢神経系血管病変と脳卒中リスクに寄与する可能性があります.
- SCDを患っている高齢の子供の昼間の軽度で未治療の低酸素は,血管閉塞エピソードのリスクを高める可能性があります.
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