红细胞分布宽度对判断植入药物洗脱支架冠心病患者的预后价值  

Prognostic value of red cell distribution width for patients treated with drug-eluting stent

作　　者：姚海木[1] 沈德良[1] 付新[1] 赵晓燕[1] 王小芳[1] 张金盈[1] 李凌[1] 

机构地区：[1]郑州大学第一附属医院心内科,河南郑州450052

出　　处：《临床荟萃》2015年第8期919-923,共5页Clinical Focus

基　　金：河南省医学科技公关计划项目(201203035)

摘　　要：目的探讨红细胞分布宽度(RDW)对判断植入药物洗脱支架(DES)非贫血冠心病患者的长期预后价值。方法选取所有在郑州大学第一附属医院心内科成功行经皮冠状动脉介入治疗(PCI)并至少植入1枚DES的冠心病患者。排除标准:接受急诊PCI的急性ST段抬高心肌梗死患者、心源性休克和近期接受输血的患者。收集患者临床及介入相关资料,采用门诊、电话和查阅再次住院病历的方法进行随访。按照入院时RDW的中位数(本研究中为13%)将患者分为2组:RDW≥13%为高RDW组,RDW<13%为低RDW组。连续数据变量组间比较应用独立t检验,分类变量的比较采用χ2检验或精确概率计算。采用Kaplan Meier方法绘制生存曲线,应用Log-rank检验进行组间比较。采用Cox回归分析确定死亡和主要心脑血管不良事件:死亡、心肌梗死和脑卒中(MACCE)的独立危险因素。P<0.05为差异具有统计学意义。结果共入选患者2 348例,完成随访2 169例(92.4%),随访时间(29.0±5.3)个月。高RDW组院内病死率和主要心脏不良事件:死亡、心肌梗死发生率(MACE)均显著高于低RDW组。随访期间高RDW组全因死亡、心源性死亡、MACCE和支架内血栓形成发生率均显著高于低RDW组。Cox多元回归分析显示RDW升高是全因死亡和MACCE的独立预测因子。高RDW组累积生存率显著低于低RDW组(P<0.05)。结论 RDW升高是植入DES的非贫血冠心病患者长期不良临床预后的独立预测因子。Objective To evaluate the long-term prognostic value of red cell distribution width （RDW） in nonanemic patients treated with drug-eluting stents （DES） for coronary artery disease （CAD）. Methods The analysis included all with CAD from the hospital who had undergone percutaneous coronary intervention （PCI） and had at least one DES implanted. Exclusion criteria were patients who had been treated with urgent PCI for acute myocardial infarction （MI）, patients presented with cardiogenic shock and patients who had received blood transfusion recently. Clinical, laboratory, angiographic and procedural data were collected. The follow-up was conducted by outpatient interviews, reviewing hospital records and via telephone interviews. Patients were divided into two groups according to the median baseline RDW （13% in this cohort）, which was measured before PCI. Patients with a RDW ≥13% were classified into the high RDW group and those with a RDW 〈13% were classified into the low RDW group. Continuous variables were expressed as mean＇4-standard deviation （SD）. Categorical variables were expressed as percentages. Continuous variables were analyzed using the Student＇s t test, Chi-square test or Fisher＇s Exact test was used for categorical variables. Cumulative survival was constructed using the Kaplan-Meier method. Log-rank test was used to compare curves. Cox regression analysis was performed to identify independent predictors of death and MACCE（death/ myocardial infarction/stroke）. Results There were 2 348 patients enrolled in the analysis and a follow up after 29.04- 5.3 months was obtained in 2 169 patients （92.4%）. The incidence of in-hospital mortality and MACCE was significantly higher in high RDW group than in low RDW group. During follow up, the incidence of all cause death, cardiac death, MACCE and stent thrombosis in high RDW group were also significantly higher than those in low RDW group. Multivariate Cox regression analysis showed that elevated RDW was an independent pre

关 键 词：冠心病 红细胞分布宽度 经皮冠状动脉介入术 病死率 

分 类 号：R541.4[医药卫生—心血管疾病]