老年H型高血压患者红细胞分布宽度与早期肾损伤的相关性研究  

Relation between red blood cell distribution width and early renal injury in elderly patients with H-type hypertension

作　　者：姜惠敏 黄立纲 田敬华[1] 杨金玲[1] 黄山[1] 尚菊菊[2] 洪燕英[1] Jiang Huimin;Huang Ligang;Tian Jinghua;Yang Jinling;Huang Shan;Shang Juju;Hong Yanying(Department of Laboratory Medicine,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010 ,China;Department of Laboratory Medicine,the First Hospital of Tsinghua Universityy Beijing 100016,China;Department of Cardiology,Beijing Hospital of Traditional Chinese Medicinef Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院检验科,100010 [2]首都医科大学附属北京中医医院心内科,100010 [3]清华大学第一附属医院检验科,北京100016

出　　处：《中国医药》2019年第10期1479-1483,共5页China Medicine

基　　金：国家中医临床研究基地业务建设科研专项(JDZX2015151)~~

摘　　要：目的探讨老年H型高血压患者红细胞分布宽度(RDW)与早期肾损伤的关系及其预测价值。方法选取2014年11月至2018年11月首都医科大学附属北京中医医院和清华大学第一附属医院收治的老年原发性高血压患者312例作为研究对象,血清同型半胱氨酸(Hcy)> 10μmol/L的H型高血压患者(202例)为观察组,血清Hcy <10μmol/L的单纯高血压患者(110例)为对照组。比较2组患者RDW、血清Hcy、尿微量白蛋白/肌肝比值(UACR)、血清肌酐、血清β2微球蛋白(β2-MG)、血清胱抑素C及估算肾小球滤过率(e GFR)。分析RDW与肾功能指标的相关性;分析早期肾损伤的危险因素;通过受试者工作特征(ROC)曲线分析各指标联合检测对早期肾损伤的诊断价值。结果观察组血清Hcy水平、RDW、UACR、血清β2-MG、血清胱抑素C水平均明显高于对照组[(24. 1±4. 1)μmol/L比(7. 9±2. 9)μmol/L、(18. 0±2. 1)%比(14. 2±2. 1)%、(97±13) mg/g比(85±18) mg/g、(9. 0±0. 3) mg/L比(6. 4±0. 6) mg/L、(1. 22±0. 20) mg/L比(0. 86±0. 11) mg/L],差异均有统计学意义(均P <0. 05)。2组血清肌酐水平和e GFR之间差异无统计学意义(P> 0. 05)。观察组早期肾损伤发生率明显高于对照组[55. 4%(112/202)比40. 0%(44/110)],差异有统计学意义(P=0. 01)。Pearson相关分析结果显示,RDW与UACR、血清β2-MG和胱抑素C水平均呈明显正相关(r=0. 34、0. 22、0. 17;P <0. 01、<0. 01、=0. 02)。多因素Logistic回归分析显示,RDW、UACR、血清β2-MG、胱抑素C、Hcy均为老年H型高血压患者发生早期肾损伤的独立危险因素(均P <0. 05)。ROC曲线分析结果显示,RDW联合UACR+β2-MG+胱抑素C诊断早期肾损伤的价值较UACR+β2-MG+胱抑素C更高(曲线下面积0. 759比0. 668,P <0. 05)。结论 RDW是老年H型高血压患者早期肾损伤独立预测指标之一,联合检测RDW及早期肾损伤指标可以提高预测价值。Objective To explore the relation between red blood cell distribution width( RDW) and early renal injury in elderly patients with H-type hypertension;to analyze the value of RDW predicting renal injury.Methods A total of 312 elderly patients with essential hypertension admitted to Beijing Hospital of Traditional Chinese Medicine,Capital Medical University and the First Hospital of Tsinghua University from November 2014 to November 2018 were enrolled. According to the level of serum homocysteine( Hcy),the patients were divided into H-type hypertension group( 202 cases,Hcy > 10 μmol/L) and simple hypertension group( 110 cases,Hcy <10 μmol/L). RDW,serum Hcy,urinary microalbumin to creatinine ratio( UACR),serum creatinine,serumβ2-microglobulin(β2-MG),serum cystatin C( Cys C) and estimated glomerular filtration rate( e GFR) were detected. Relation between RDW and renal function indicators and risk factors of early renal injury were analyzed.Diagnostic values of combined indexes for early renal injury were analyzed by receiver operating characteristic( ROC) curve. Results Levels of serum Hcy,RDW,UACR,serum β2-MG and serum Cys C in observation group were significantly higher than those in control group[( 24. 1 ± 4. 1)μmol/L vs( 7. 9 ± 2. 9)μmol/L,( 18. 0 ±2. 1)% vs( 14. 2 ± 2. 1)%,( 97 ± 13) mg/g vs( 85 ± 18) mg/g,( 9. 0 ± 0. 3) mg/L vs( 6. 4 ± 0. 6) mg/L,( 1. 22 ± 0. 20) mg/L vs( 0. 86 ± 0. 11) mg/L]( all P < 0. 05). Levels of serum creatinine and e GFR showed no significant differences between groups( P > 0. 05). Incidence of early renal injury in observation group was significantly higher than that in control group[55. 4%( 112/202) vs 40. 0%( 44/110)]( P = 0. 01). Pearson analysis showed that RDW was positively correlated with UACR,serum β2-MG and Cys C( r = 0. 34,0. 22,0. 17;P < 0. 01,< 0. 01,= 0. 02). Multivariate logistic regression showed that RDW,UACR,serum β2-MG,Cys C and Hcy were independent risk factors of early renal injury( all P < 0. 05). ROC curve indicated that the predictive value of

关 键 词：H型高血压 红细胞分布宽度 肾功能损伤 

分 类 号：R544.1[医药卫生—心血管疾病]