红细胞分布宽度与特发性肺动脉高压病情和预后的相关性分析  

Correlation Study Between Red Cell Distribution Width With the Condition and Prognosis in Patients of Idiopathic Pulmonary Arterial Hypertension

作　　者：李震南[1] 柳志红[1] 顾晴[1] 倪新海[1] 程显声[1] 何建国[1] 熊长明 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院国家心血管病中心心血管疾病国家重点实验室,北京市100037

出　　处：《中国循环杂志》2013年第2期111-114,共4页Chinese Circulation Journal

基　　金：国家“十一五”科技支撑计划资助项目(2006BA101A07);首都医学发展科研基金项目(2009-1003)

摘　　要：目的:探讨红细胞分布宽度(RDW)与特发性肺动脉高压病情和预后的相关性。方法:连续入选经右心导管确诊为特发性肺动脉高压的患者76例。以RDW 13.5%作为界值将患者分为RDW≥13.5%组(n=43)与RDW<13.5%组(n=33)。对基线资料进行相关性分析及分组探讨,对随访结果绘制ROC曲线并作生存分析及COX回归。结果:相关分析结果显示,RDW与WHO肺动脉高压功能分级、右心室舒张末期前后径、N末端B型利钠肽原(NT-ProBNP)、大内皮素1呈正相关(r=0.40,P<0.001;r=0.29,P=0.013;r=0.36,P=0.002;r=0.31,P=0.012),与六分钟步行距离、左心室舒张末期前后径、心指数呈负相关(r=-0.3,P=0.029;r=-0.3,P=0.01;r=-0.27,P=0.019)。与NT-ProBNP、大内皮素-1相比,只有RDW预测患者两年内不良事件(死亡)发生的ROC曲线有统计学意义(P=0.003),曲线下面积0.766,以RDW 13.5%作为界值预测患者死亡的敏感度为0.9,特异度为0.7。Kaplan-Meier生存曲线:RDW<13.5%组预后明显好于RDW≥13.5%组,log-rank检验P<0.001,差异有统计学意义。RDW≥13.5%组患者的肺动脉高压功能分级、NT-ProBNP和大内皮素-1水平较RDW<13.5%组偏高,差异有统计学意义(P<0.05)。多因素COX回归显示,排除其他因素影响后,RDW≥13.5%仍是患者死亡的独立危险因素。结论:RDW与特发性肺动脉高压的病情和预后相关。高水平的RDW提示病情较重,预后较差,也是发生不良事件的独立危险因素。Objective： To explore the relationship between circulating red cell distribution width （RDW） with the condition and prognosis in patients of idiopathic pulmonary arterial hypertension （IPAH）. Methods： A total of 76 consecutive IPAH patients with confirmed diagnosis of right heart catheterization were enrolled in our work. Taking the cut-offvalue of RDW=13.5%, the patients were divided into 2 groups as RDW≥ 13.5% group, n=43 and RDW〈13.5% group, n=33. The baseline condition was recorded and compared between 2 groups and the follow-up outcome was studied with ROC curves and Cox regression survival analysis. Results： The correlation analysis indicated that RDW level positively related to WHO functional class （WHO-FC）, （r = 0.40, P〈0.001）, right ventricular end diastolic diameter （r=0.29, P=0.013）, NT-ProBNP （r=-0.36, P=0.002）, endothelin-1 （r=0.3 1, P= 0.012）; and negatively related to 6 minutes walking distance （r=-0.3, P=0.029）, left ventricular end diastolic diameter （r=-0.3, P=0.01）, and cardiac index （r =-0.27, P=0.019）. ROC curve presented that compared with NT-ProBNP and endothelin-1, RDW was the effective predictor for 2 year all-cause mortality in IPAH patients, P=0.003, the area under the curve was 0.766. Based on cut-off value of 13.5%, the sensitivity for RDW prediction in IPAH mortality was 88.9%, in specificity was 66.7%. Survival analysis showed that RDW〈13.5% group had better prognosis than RDW ≥ 13.5% group, P〈0.001. RDW ≥13.5% group had higfier levels of WHO-FC, NT-ProBNP and endothelin-1 than that in RDW〈13.5% group, P〈0.05.Multi-Cox regression analysis suggested that RDW ≥ 13.5% is an independent risk factor for death in IPAH patients. Conclusion： RDW level related to clinical condition and prognosis in IPAH patients. Higher level of RDW indicated worse condition with poor prognosis, it was an independent risk factor for adverse events.

关 键 词：红细胞分布宽度 特发性肺动脉高压 预后 

分 类 号：R54[医药卫生—心血管疾病]