【作者】 裴国勇；

【导师】 刘志华；

【作者基本信息】 苏州大学 ， 心血管内科， 2010， 硕士

【摘要】 目的:1.了解慢性心力衰竭(CHF)患者红细胞分布宽度(RDW)与心功能的关系。2.探讨RDW在CHF患者预后判断中的价值。方法:入选病例为2005年3月至2008年9月住院的248例心衰患者和105例无慢性心衰的患者。分析RDW与美国纽约心脏病协会(NYHA)心功能分级级数、左室射血分数(LVEF)、氨基末端B型钠尿肽原(NT-proBNP)、血红蛋白(Hb)及估测肾小球滤过率值(eGFR)的关系。随访21.6(1～54)月,观察终点为全因死亡和心衰恶化再住院。分析RDW与不同预后的关系,采用Kaplan-Meier法分析绘制无事件生存曲线,并进行比较。以事件为应变量,随访截尾时间或事件发生时间为生存时间变量,以性别、年龄、NYHA分级、Hb、RDW、LVEF、eGFR为自变量行COX多元逐步回归分析。结果:(1)心衰组RDW显著高于对照组(14.92±1.90%vs12.81±0.73%,P<0.001),且随NYHA心功能分级级数的增高而显著升高(P均<0.001);(2)LVEF>40%亚组RDW明显低于LVEF≤40%亚组(13.51±0.91%vs15.43±1.92%,P<0.001)但仍显著高于对照组(13.51±0.91%vs12.79±0.68%,P<0.001);RDW与LVEF之间呈显著负相关(,r=-0.4505,P<0.001)(;3)心衰组RDW与log(NT-proBNP)显著正相关(r=0.4868,P<0.001);(4)死亡组和再住院组RDW值均显著高于无事件生存组(16.86±2.55%、15.18±1.91%vs14.29±1.45%,P均<0.001),且死亡组RDW值显著高于再住院组(16.86±2.55% vs15.18±1.91%P<0.005);生存曲线显示RDW≥16%亚组生存时间显著低于其他亚组(P<0.001);COX多元回归分析结果显示,NYHA分级、LVEF、eGFR及RDW均是患者终点事件发生的独立预测因素(P分别为0.015,0.040,0.000和0.000),(5)心衰组RDW与Hb无相关性(P>0.05)、与eGFR显著负相关(r= -0.280, P<0.001),在校正了LVEF、NYHA分级及NT-proBNP后,RDW与eGFR仍呈负相关(r=-0.149,P=0.019)。结论:心衰患者RDW增高与慢性心力衰竭的严重程度有关,RDW对慢性心衰患者的预后判断有一定价值,是死亡和再住院事件的独立预测因素。更多还原

【Abstract】 Objective: The objective of this study was to investigate the relationship between red blood cell distribution width (RDW) and the cardiac function in patients with chronic heart failure and to evalute the prognostic value of RDW in patients with chronic heart failure. Method: 248 cases of patients with chronic heart failure and 105 patients without chronic heart failure patients were consecutively selected from the hospitalized patients from March 2005 to September 2008. Analysis of the relationship between RDW and New York Heart Association (NYHA ) cardiac function classification series, left ventricular ejection fraction (LVEF),amino-terminal B-type natriuretic peptide(NT-proBNP),Hb and eGFR. Follow-up of 21.6 (1 -54) months to observe the end point including all-cause mortality and re-hospitalization due to worsening heart failure. Analysis of the relationship between RDW and different outcomes. Draw and compared the event-free survival curves using Kaplan-Meier survival analysis. The event was entered as a variable, censored follow-up time or event time for the survival time variable.We used COX stepwise regression analysis with gender, age, NYHA class, Hb, RDW, LVEF, eGFR were entered as variables . Results:(1) RDW in heart failure group were significantly higher than in control group (14.92±1.90% vs 12.81±0.73%, P <0.001), and RDW increased significantly with NYHA class elevated (P all <0.001); (2) RDW in LVEF> 40% sub-group was significantly lower than LVEF≤40% sub-group (13.51±0.91% vs 15.43±1.92%, P <0.001) but significantly higher than control group (13.51±0.91% vs12.79±0.68%, P <0.001); RDW between LVEF was significantly negatively correlated, (r =- 0.4505, P <0.001); (3) RDW between log (NT-proBNP) was significant positive correlation in heart failure group (r = 0.4868, P <0.001); (4) RDW in death group and in re-hospitalization group were significantly higher than in survival group without events(16.86±2.55%、15.18±1.91% vs14.29±1.45% , P all <0.001), and RDW in death group was significantly higher than in re-hospitalization group (16.86±2.55% vs15.18±1.91%,P <0.005); The survival curve showed that survival time in sub-group of RDW≥16% was significantly lower than in other sub-groups (P <0.001); COX regression analysis showed that NYHA class, LVEF, eGFR, and RDW are to be the independent predictors of end events in patients with heart failure,(P = 0.015, 0.040,0.000 and 0.000). (5) RDW between Hb was no correlation in heart failure group (P> 0.05), and RDW between eGFR was significantly negative correlation (r = -0.280 , P <0.001), and eGFR remain a negative correlation even after adjusted for LVEF, NYHA class, NT-proBNP and RDW .(r = -0.149, P = 0.019).Conclusion:In this study, We observed that elevated RDW is correlated with the severity in patients with heart failure. Furthermore ,RDW have some value on the prognosis of patients with chronic heart failure and RDW is an independent predictor of events for death and re-hospitalization.更多还原