慢性心力衰竭患者红细胞体积分布宽度变化意义的初步探讨  

Study of the effects of changing of red blood cell volume distribution width ＇s chang on chronic heart failure patients

作　　者：林榕 林明[2] 张文文[2] 李培蕾[2] 

机构地区：[1]涵江医院心内科,福建省莆田市350005 [2]福建医科大学附属第一医院心内科

出　　处：《中国心血管病研究》2010年第10期741-747,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨红细胞体积分布宽度（RDW）随慢性心力衰竭（CHF）患者心功能变化而产生的变化，分析RDW与CHF的病情及预后的关系，并探讨其可能的机制及意义。方法分析200例住院慢性心力衰竭患者，根据纽约心功能分级分为心功能Ⅱ级组、心功能Ⅲ级组、心功能Ⅳ级组；并根据左室射血分数（LVEF）分为LVEF≥50％组（B组）、50％〉LVEF≥35％组（C组）和LVEF〈35％组（D组）；来自同期住院无慢性心力衰竭的对照组（A组）。比较RDW、N-末端脑钠肽前体（NT—proBNP）、LVEF在各组间的变化。分析26例CHF患者治疗前后RDW、NT—proBNP的变化。采用线性相关关系和多元线性逐步回归法分析各因素与RDW变化的相关性。用ROC曲线评定RDW判断CHF的价值。结果①从对照组到心功能Ⅳ级组，RDW逐渐增加，各组间两两比较差异均具有统计学意义（P〈O．01）。②随着LVEF的降低，RDW逐渐增加，各组间两两比较差异均具有统计学意义（P〈0．05）。③26例CHF患者治疗前后RDW及LgNT—proBNP均有显著性下降（P〈0．01）。④在CHF患者中，RDW水平与LgNT—ProBNP直线相关关系最强（P〈0．05）。⑤通过多元线性逐步回归法分析得出回归方程为：RDW=13．734＋1．518（LgNT—Pr0BNP）-0．026（年龄）-O．333（LAD）-0．012（LVEF）。@RDW判断CHF的ROC曲线下面积为0．697，P〈0．01。结论①cHF患者RDW明显升高，且与心衰程度有关系。②RDW与kNT—ProBNP有较强的相关性，甚至比LVEF还强，提示RDW可能与CHF患者的预后有关。Objective To study the change of red blood cell volume distribution width （RDW） accompanied by the cardiac function＇s change in chronic heart failure （CHF） patients,and analyze the relationship between RDW and the condition and prognosis of CHF,and to explore its possible mechanism and significance. Methods 200 chronic heart failure patients in hospital were divided into 3 groups based on New York Heart Association functional class：NYHA Ⅱ group, NYHA Ⅲ group,NYHA Ⅳ group,and divided into 3 groups based on left ventricular ejection fraction （LVEF） ： LVEF ≥ 50% group （B group）, 50% 〉LVEF ≥ 35% group （C group）, LVEF〈35% group （D group）. 82 patients who were not diagnosed as CHF were selected as the control group （A group）. The changes of RDW, NT-proBNP and LVEF were compared in all groups. The changes of RDW, NT- proBNP before and after treatment in 26 CHF patients were analyzed. The correlation of RDW and a variety of parameters was analyzed by linear correlation and multiple linear stepwise regression. ROC curve was used to assess the value of RDW in determining CHF. Results （1）From the control group to NYHA Ⅳ group, RDW gradually increased. There was significant difference among the four groups（P〈0.01 ）.（2）Accompanied by the decline of LVEF （from group A to D）,RDW gradually increased. There was significant difference among the four groups （P〈0.05）. （3）Before and after treatment in 26 CHF patients, RDW and LgNT-preBNP were both significantly declined （P〈 0.01 ）. （4） In CHF patients, there were strongest significant linear correlation between RDW and LgNT-ProBNP. （5） The regression equation obtained by multiple linear stepwise regression was RDW=13.734＋1.518（LgNT-ProBNP）- 0.026（age）-0.333（LAD）-0.012（LVEF）.（6）The area under the ROC curve that RDW to determine the CHF was 0.697, P〈0.01. Conclusion （1）We found that RDW significantly increases in CHF patients and correlated with the degree of heart fa

关 键 词：红细胞体积分布宽度 慢性心力衰竭 纽约心脏协会心功能分级 N-末端脑钠肽前体 

分 类 号：R541.6[医药卫生—心血管疾病]