血浆是引起血沉增快的主要因素

目的：阐明血沉增快的原因是血浆还是红细胞。方法：收集72例血沉异常的抗凝血标本,同时收集血型相对应的72例血沉正常标本,组成血型相同的血沉异常和正常标本72对,每对互换血浆后重新测定血沉,与原始血沉结果比较,并通过多元线性回归分析血沉与血浆蛋白及血脂浓度的关系。结果：血沉异常标本的红细胞加入血沉正常标本的血浆后,72例（100%）血沉均减慢,其中30例血沉下降90%以上,35例下降70%-90%,7例小于70%。血沉正常标本的红细胞加入血沉异常标本的血浆后,67例（93%）血沉加快,其中58例（81%）变为异常（18例血沉加快10倍以上,40例加快5-10倍）。球蛋白、白蛋白和纤维蛋白原与血沉具有线性关系,球蛋白（r=0.420,P〈0.001）和纤维蛋白原（r=0.673,P〈0.001）与血沉呈正相关,而白蛋白（r=-0.558,P〈0.001）与血沉呈负相关。结论：血沉增快主要与血浆因素相关,红细胞对于血沉的影响作用很小。

Plasma as the Main Influential Factor for the Increased Erythrocyte Sedimentation rate

Objective： To clarify whether the red blood cell or plasma is the main influential factor for the increased erythrocyte sedimentation rate（ESR）.Methods： Seventy-two pairs of anticoagulant blood samples,each consisting of a normal ESR sample and an abnormal ESR sample with the same blood type,were included.ESR was retested after exchanging the plasmas in each pair,and ESR before and after the plasma exchange was compared.The relationship between ESR and the concentration of plasma proteins or lipids was analyzed through multiple linear regression analysis.Results： After the red blood cells from abnormal ESR samples were mixed with the plasmas from normal ESR samples,ESR of all 72 samples decreased,among which 30 samples decreased by 90 %,35 decreased by 70 %-90 %,and 7 samples decreased by 70 %.On the other hand,when the red blood cells of normal ESR samples were mixed with the plasmas of abnormal ESR samples,ESR of 67 samples（93 %） increased,among which 58 samples（81%） exceeded normal range.Multiple linear regression analysis revealed that albumin,globulin,and fibrinogen had linear relationships with ESR.There was a negative correlation between ESR and albumin（r =-0.558,P 0.001）,whereas there was positive correlation between ESR and globulin（r = 0.420,P0.001） or fibrinogen（r = 0.673,P 0.001）.Conclusion： Increased ESR is mainly associated with plasma,whereas red blood cells have minimal effect on ESR.