红细胞体积分布宽度对急性失代偿射血分数保留心力衰竭患者预后的预测价值  

Prognostic value of red blood cell volume distribution width in patients with acute decompensated heart failure with preserved ejection fraction

作　　者：郭庆宏 唐龙 冯启凡 奚小土[3] GUO Qinghong;TANG Long;FENG Qifan;XI Xiaotu(Department of Emergency,People′s Hospital of Xuancheng City,Anhui Province,Xuancheng242000,China;Department of Cardiology,People′s Hospital of Xuancheng City,Anhui Province,Xuancheng242000,China;Department of Emergency,Guangdong Hospital of Traditional Chinese Medicine,Guangdong Province,Guangzhou510000,China)

机构地区：[1]安徽省宣城市人民医院急诊科,安徽宣城242000 [2]安徽省宣城市人民医院心内科,安徽宣城242000 [3]广东省中医院急诊科,广东广州510000

出　　处：《中国医药导报》2020年第23期20-23,27,共5页China Medical Herald

基　　金：安徽省科技计划项目(1504a080136)。

摘　　要：目的探讨红细胞体积分布宽度(RDW)对急性失代偿射血分数保留心力衰竭(HFpEF)患者预后的预测价值。方法选择2014年1月—2018年12月安徽省宣城市人民医院收治的急性失代偿HFpEF患者129例,检测入院RDW水平,随访12个月,根据随访期间急性心力衰竭相关死亡和再住院情况将患者分为预后良好组和预后不良组。比较两组基线资料,采用受试者操作特征(ROC)曲线分析RDW预测急性失代偿HFpEF患者预后的价值。结果121例患者完成随访,预后不良组37例,预后良好组84例。两组的年龄、原发性高血压占比、糖尿病占比、心房颤动病史、美国纽约心脏病协会(NYHA)分级及肌酐、丙氨酸氨基转移酶、肌钙蛋白I、RDW水平比较差异均有统计学意义(P<0.05)。多元logistic回归分析结果显示:房颤病史(OR=1.865,95%CI:1.325~12.592)、NYHA分级(OR=1.536,95%CI:1.205~10.628)、RDW(OR=2.298,95%CI:1.406~16.274)与急性失代偿HFpEF患者不良预后相关(均P<0.01)。ROC分析结果显示:RDW预测急性失代偿HFpEF预后的最佳截断值为15%,曲线下面积为0.724,敏感度为72.97%,特异度为66.67%。结论RDW上升与急性失代偿HFpEF患者不良预后密切相关,RDW可作为预测急性失代偿HFpEF患者预后的辅助指标。Objective To explore prognostic value of red blood cell distribution width(RDW)in patients with acute decompensated heart failure with preserved ejection fraction(HFpEF).Methods One hundred and twenty-nine patients with acute decompensated HFpEF admitted to People′s Hospital of Xuancheng City from January 2014 to December 2018 were selected.RDW level on admission was measured and followed up for 12 months.Patients were divided into good prognosis group and poor prognosis group according to the death and re-hospitalization of acute heart failure during the follow-up period.Clinical baseline of two groups was compared,and the value of RDW in predicting the prognosis of acute decompensated HFpEF patients was analyzed by receiver operating characteristic(ROC)curve.Results One hundred and twenty-one patients were followed up,37 cases in poor prognosis and 84 cases in good prognosis.The age,the proportion of essential hypertension,the proportion of diabetes,atrial fibrillation,New York Heart Disease Association(NYHA)grade,creatinine,alanine aminotransferase,troponin I and RDW levels between two groups were compared,the differences were statistically significant(P<0.05).Multiple logistic regression analysis showed that the history of atrial fibrillation(OR=1.865,95%CI:1.325-12.592),NYHA grade(OR=1.536,95%CI:1.205-10.628)and RDW(OR=2.298,95%CI:1.406-16.274)were related to the poor prognosis of acute decompensated HFpEF(all P<0.01).ROC analysis results showed that RDW predicted acute decompensated HFpEF prognosis with the best cut-off value of 15%,the area under the curve was 0.724,the sensitivity was 72.97%,and the specificity was 66.67%.Conclusion The rise of RDW is closely related to the poor prognosis of acute decompensated HFpEF patients.RDW can be used as an auxiliary index to predict the prognosis of acute decompensated HFpEF patients.

关 键 词：红细胞体积分布宽度 射血分数保留心力衰竭 预后 预测价值 

分 类 号：R541.6[医药卫生—心血管疾病]