红细胞分布宽度对接受择期经皮冠状动脉介入治疗非贫血患者预后的影响  

The impact of red blood cell distribution width on outcome of elective percutaneous coronary intervention in non-anemia patients

作　　者：刘新民[1] 董建增[1] 刘小慧[1] 康俊萍[1] 罗太阳[1] 关杨[1] 戴天医[1] 张崟[1] 白融[1] 杜昕[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华内科杂志》2016年第12期937-940,共4页Chinese Journal of Internal Medicine

摘　　要：目的了解红细胞分布宽度（RDW）水平与接受择期经皮冠状动脉（冠脉）介入治疗（PCI）的非贫血患者术后病死率的关系。方法入选2009年7月至2011年9月接受择期PCI治疗并且术前有RDW和血红蛋白（Hb）记录的非贫血患者2732例。贫血诊断采用世界卫生组织的Hb标准，女性〈120g／L，男性〈130g／L。根据术前RDW中位数（12．1％），将患者分为两组，低RDW组（RDW〈12．1％）1371例，高RDW组（RDW〉t12．1％）1361例。平均随访时间为18个月，随访率为92．1％，比较两组患者的临床特点和术后病死率的差异。结果高RDW组患者年龄较大；女性、高血压、脑血管病、陈旧性心肌梗死病史比例较高；收缩压、TC水平较高；当前吸烟比例、左心室射血分数、红细胞平均体积、Hb、肾小球滤过率水平较低。另外，高RDW组患者合并左主干、冠脉开口、慢性完全闭塞病变比例较高，完全血管重建率低（72．4％比76．1％，P=0．024）。高RDW组患者术后病死率明显高于低RDW组（2．4％比0．6％，P〈0．001）。多因素Cox回归分析，校正其他因素后，高RDW是PCI术后死亡的独立危险因素（HR3．930，95％CI1．600—9．656，P=0．003）。结论高RDW是接受择期PCI治疗的非贫血患者术后病死率增加的独立危险因素。Objective Previous studies have revealed that the red blood cell distribution width （RDW） was associated with long-term prognosis in patients undergoing percutaneous coronary intervention （PCI）. However, they did not exclude patients with anemia. This study, thus, investigated the association between RDW and prognosis in non-anemia patients. Methods A total of 2 732 patients underwent elective PCI from July 2009 to September 2011 were enrolled in the study. These patients were divided into two groups based on their baseline median RDW levels： low RDW group （ RDW 〈 12. 1% ） and high RDW group （RDW≥12. 1% ）. All the subjects were followed up for an average period of 18 months and the associations between baseline RDW levels and postoperative mortality were analyzed. Results Patients in the high RDW group were elder and had more women than those in low RDW group. Most of them had prior history of hypertension, stroke, myocardial infarction, but few of them were current smokers. Subjects in the high RDW group had higher systolic blood pressure and total cholesterol levels, and lower erythroeyte mean corpuscular volume, hemoglobin level, estimated glomerular filtration rate level, and left ventrieular ejection fraction. Moreover, more subjects in the high RDW group were combined with left main, ostial and chronic total occlusion lesion, and had a lower complete revascularization rate. The postoperative mortality was significantly higher in the high RDW group than that in the low RDW group （2.4% vs 0. 6%, P 〈0. 001 ）. Multivariate Cox regression analysis revealed that preoperative high RDW level was an independent risk factor for postoperative mortality after adjustment of other factors （ HR 3. 930,95% CI 1. 600 - 9. 656, P = 0. 003 ）. Conclusion High RDW might be a marker for the postoperative mortality in non-anemic patients undergoing elective PCI.

关 键 词：红细胞分布宽度 血管成形术 预后 

分 类 号：R541.4[医药卫生—心血管疾病]