红细胞分布宽度与急诊PCI的急性冠脉综合征患者病变程度及预后的关系  

The relationship between red blood cell distribution width and ACS extent of lesions and prognosis in patients undergoing emergency PCI

作　　者：张利峰[1] 王献忠[1] 朱国英[1] 申子路[1] 杨淑英 

机构地区：[1]邯郸市第一医院心血管内科,河北省邯郸市056000 [2]永年县中医院内科,河北省邯郸市056000

出　　处：《中国心血管病研究》2016年第1期78-82,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨红细胞分布宽度（RDW）增高与急性冠脉综合征（ACS）患者病变程度和行急诊PCI术后患者预后的关系,以及与心血管疾病发展的相关机制.方法 收集临床诊断为ACS入院并行急诊PCI的患者资料106例,根据患者冠状动脉造影结果,采用Gensini评分对每位患者冠脉病变程度进行定量分析,分别比较各亚组间RDW水平,探讨RDW与冠状动脉病变程度的相关性.随访所有患者至发生心血管不良事件止（MACE）.将患者分成MACE组和无MACE组,并进行单因素分析,得出有统计学意义的危险因子进行多因素回归分析.根据人院24 h首次红细胞分布宽度中位数检测结果,将患者分为低RDW和高RDW组,并观察其随访期内心血管不良事件的发生有无差别.结果 分析显示,RDW与Gensini评分呈正相关,是早期预测冠心病病变程度的预测因子.与低RDW组相比,高RDW组患者年龄较大（66.97岁比58.90岁）、平均红细胞血红蛋白浓度（MCHC）减低（337.70 g/L比345.02 g/L）、LVEF偏低（0.44比0.57）、WBC明显增加（11.23×10E9/L比9.60× 10E9/L）、hs-CRP明显升高（9.94 mg/L比6.65 mg/L）.高RDW组随访期间心力衰竭（25比2）、再次心梗（5比1）、心源性死亡（2比0）、MACE总数（35比5）均明显增加,差异有统计学意义.结论 RDW与急性冠脉综合征患者冠脉病变严重程度密切相关.RDW值对急诊PCI的ACS患者预后有预测价值.高水平RDW值的ACS患者行急诊PCI主要心血管不良事件发生率高,预后较差.炎症反应是高RDW水平的ACS患者行急诊PCI预后不良的可能机制.Objective To discussion the relationship between the increased of RDW （red blood cell dis- tribution width） with the severity of the patient and the emergency line ACS patients after PCI prognosis, and to investigate the possible mechanisms of cardiovascular disease and the increased of RDW. Methods 106 cases that clinical diagnosis of ACS patients admitted to hospital and underwent emergency PCI were enrolled. According to the results of coronary angiography and quantitative Gensini score of coronary lesion of each patient, the different subgroups levels of RDW and the relationship between RDW and the degree of the coronary artery lesions were compared. Adverse cardiovascular events were followed and divided patients into MACE and MACE group. The risk factors were analyzed by multiple factors regression analysis. The patients were divided into low RDW and high RDW group according to the median hospital 24 hours of red blood cell distribution width, and the occurrence of cardiovascular adverse events were observed during follow-up period. Results RDW was positively correlated with Gensini score, it was an early predictor of coronary lesions; the results show that compared with low RDW group, the most older patients was in high RDW group （66.97 vs 58.90）, the average red blood cell hemoglobin concen- tration（MCHC） reduced（337.70 vs 345.02）, LVEF was low（0.44 vs 0.57）, but the WBC and the hs-CRP in- creased significantly（11.23 vs 9.60）, （9.94 vs 6.65）. The heart failure（25 vs 2）, reinfarction（5 vs 1）, cardiac death （2 vs 0）, the total number of MACE （35 vs 5 ）, which in high RDW group, were significantly increased. The difference was statistically significant. Conclusion RDW closely associated with acute coronary syndrome coronary disease severity. The RDW values of emergency PCI value can be used to predict the prognosis of patients with ACS. High levels of RDW values in ACS patients underwent emergency PCI has high incidence of major ad- verse cardiovascular events and

关 键 词：红细胞分布宽度 GENSINI评分 预后 经皮冠状动脉介入治疗 炎症 

分 类 号：R543.3[医药卫生—心血管疾病]