RDW与急性心肌梗死预后的相关性研究  

Relation between red cell distribution width and clinical outcomes after acute myocardial infarction

作　　者：陈倩[1] 王斐[1] 郭野[1] 黄春梅[1] 杨卓[1] 崔巍[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院检验科,北京100730

出　　处：《中国卫生检验杂志》2011年第3期559-562,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的:研究红细胞分布宽度(RDW)与急性心肌梗死(AMI)患者心功能分级(Killip分级)的关系,以及与脑钠肽(BNP)和超敏C反应蛋白(hs-CRP)之间的相关性,从而探讨RDW在诊断AMI及判断预后中的作用。方法:回顾性分析了2006年12月-2009年12月入住我院的345例AMI患者,根据临床症状和肺部有无啰音、啰音范围和收缩压进行Killip分级。利用Simens-Bayer Advia 2120全血细胞分析仪、Triage全自动免疫分析系统、Olympus AU5421全自动生化分析仪分别检测患者的RDW、血红蛋白(Hb)、血细胞比容(HCT)、平均红细胞体积(MCV)、BNP以及hs-CRP等指标。分析Killip各级之间RDW的变化趋势,同时对RDW与BNP和hs-CRP之间的相关性进行分析。结果:Killip II级及以上患者的RDW值明显高于Killip I级患者的RDW(13.75 vs13.07,P<0.001),但Killip II级I、II级及IV级之间RDW的结果没有显著差异(P II/III=0.498、P II/IV=0.418、P III/IV=0.817),Killip I级患者的RDW值均位于参考范围内。RDW与BNP显著相关(r=0.178,P<0.05),而与hs-CRP不具有相关性(r=0.065,P>0.05)。在校正了年龄、性别、HGB、HCT和MCV等因素后,BNP仍可独立预测RDW(R2=0.032,P<0.05)。结论:RDW在出现心力衰竭的AMI患者中明显高于心功能正常的AMI患者,可用于判断AMI心力衰竭的发生。Objective：To investigate the relation between red cell distribution width（RDW） and Killip classification of patients with acute myocardial infarction（AMI）,and to research the correlation of RDW with BNP and hs-CRP.To discuss the prognostic role of RDW in AMI. Methods：Perform a post hoc analysis included 345 patients with AMI between December 2006 and December 2009.The Killip classification is executed by cardiologist depended on the clinical symptoms and the tests.RDW,hemoglobin（HGB）,hematocrit（HCT）,mean corpuscular volume（MCV）,brain natriuretic peptide（BNP） and high-sensitivity C-reactive protein（hs-CRP） were tested to determine the dynamic changes of RDW at different Killip classification of the disease. At the same time,we analyzed the correlation of the level of RDW with the level of BNP and hs-CRP.Results：The RDW of patients in Killip class II,III and IV was higher than those in Killip class I（13.75 vs 13.07,P0.001）.But the difference of RDW among Killip Class II,III and IV was not significant（PII/III=0.498,PII/IV=0.418,PIII/IV=0.817）.Plasma BNP（r=0.178,P0.05） but not hs-CRP（r=0.065,P0.05） levels correlated with RDW.After adjustment for potential confounders including age,gender,HGB,HCT and MCV,RDW was independently predicted by BNP（r2=0.032,P0.05）.Conclusion：RDW value of AMI patients who had heart failure was higher than that of patients who had no evidence of heart failure,so RDW can be used to diagnose the event of heart failure.

关 键 词：红细胞体积分布宽度 急性心肌梗死 KILLIP分级 

分 类 号：R542.22[医药卫生—心血管疾病]