红细胞分布宽度与慢性阻塞性肺疾病所致肺动脉高压的相关性分析
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摘要
目的探讨红细胞分布宽度(red cell distribution width,RDW)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)所致肺动脉高压的相关性。方法门诊随诊的稳定期COPD患者198例,根据心脏彩色超声估算肺动脉收缩压(pulmon aryarterial systolic pressure,PASP),并根据PASP分为重度肺动脉高压组(PASP>70mmHg)45例,中度肺动脉高压组(PASP>50~70mmHg)50例,轻度肺动脉高压组(PASP 35~50mmHg)47例,正常肺动脉压组(PASP<35 mmHg)56例,选取同期健康体检者50例为对照组,检测各组RDW、肺功能、血气分析并进行比较。结果 RDW、PaCO_2随PASP严重程度增高而升高,其中PaCO_2在正常肺动脉高压组与对照组差异无统计学意义(P>0.05),其他各组之间两两比较,差异均有统计学意义(P<0.05)。PaO_2、第一秒用力呼气容积占预计值的百分比(FEV_1%pred)、第一秒用力呼气量占用力肺活量比值(FEV_1/FVC)随PASP严重程度增高而降低(P<0.05)。RDW与PASP呈显著正相关(r=0.745,P=0.000),RDW与FEV_1%pred、FEV_1/FVC、pH、PaO_2均呈负相关(r=-0.678、-0.696、-0.306、-0.629,P=0.000),其中与pH相关性程度较低。结论 RDW可作为COPD所致肺动脉高压的评估指标之一;酸中毒及低氧血症也可能是导致RDW升高的原因。
Objective To explore the relationship between circulating red cell distribution width(RDW)and the pulmonary arterial hypertension in patients with chronic obstructive pulmonary disease.Methods According to the degree of pulmonary artery pressure,patients are divided into normal pulmon artery pressure group(<35 mmHg,n=56),mild pulmon artery pressure group(35-50 mmHg,n=47),moderate pulmon artery pressure group(>50-70 mmHg,n=50)and severe pulmon artery pressure group(>70 mmHg,n=45).Fifty healthy persons served as control group,The RDW and pulmonary function and arterial blood gas analysis were measured and compared.Results The RDW and PaCO_2 were increased with the increase of pulmon aryarterial systolic pressure(PASP)(P<0.05),but PaCO_2 had no difference between control group and normal pulmon artery pressure group.The PaO_2,forced expiratory volume in one second to pred(FEV_1/pred)and forced vital capacity rate of one second(FEV_1/FVC)were decreased of with the increase of PASP(P<0.05).The RDW was significantly positive correlated with pulmonary hypertension(r=0.745,P=0.000).The FEV_1%pred,FEV_1/FVC,pH,PaO_2 were negatively correlated with RDW(r=-0.678,-0.696,-0.306,-0.629,P=0.000).Conclusion RDW can be used as one of the evaluation indicators of decline in lung function in patients with chronic obstructive pulmonary disease,and acidosis and hypoxemia are also the main reasons for the RDW.
Objective To explore the relationship between circulating red cell distribution width(RDW)and the pulmonary arterial hypertension in patients with chronic obstructive pulmonary disease.Methods According to the degree of pulmonary artery pressure,patients are divided into normal pulmon artery pressure group(<35 mmHg,n=56),mild pulmon artery pressure group(35-50 mmHg,n=47),moderate pulmon artery pressure group(>50-70 mmHg,n=50)and severe pulmon artery pressure group(>70 mmHg,n=45).Fifty healthy persons served as control group,The RDW and pulmonary function and arterial blood gas analysis were measured and compared.Results The RDW and PaCO_2 were increased with the increase of pulmon aryarterial systolic pressure(PASP)(P<0.05),but PaCO_2 had no difference between control group and normal pulmon artery pressure group.The PaO_2,forced expiratory volume in one second to pred(FEV_1/pred)and forced vital capacity rate of one second(FEV_1/FVC)were decreased of with the increase of PASP(P<0.05).The RDW was significantly positive correlated with pulmonary hypertension(r=0.745,P=0.000).The FEV_1%pred,FEV_1/FVC,pH,PaO_2 were negatively correlated with RDW(r=-0.678,-0.696,-0.306,-0.629,P=0.000).Conclusion RDW can be used as one of the evaluation indicators of decline in lung function in patients with chronic obstructive pulmonary disease,and acidosis and hypoxemia are also the main reasons for the RDW.
引文
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[14]李慧芬,赵家慧.低分子肝素钙与肝素治疗AECOPD呼吸衰竭的效果及对PEFR的影响[J].河北医科大学学报,2016,37(8):957-960.
[15]Kurto4lu E,Aktürk E,Korkmaz H,et al.Elevated red blood cell distribution width in healthy smokers[J].Turk Kardiyolo Dern Ars,2013,41(3):199-206.
[16]Seyhan EC,zgül MA,Tutar N,et al.Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease[J].COPD,2013,10(4):416-424.
[17]Balta S,Aydogan M,Demirkol S,et al.Red cell distribution width:a novel and simple predictor of mortality in chronic obstructive pulmonary disease[J].COPD,2014,11(4):475-476.
[18]Wang W,Liu J,Yang YH,et al.Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension[J].Clin Respir J,2016,10(1):54-60.
[19]Subhashree AR,Shanthi B,Parameaswari PJ.The red cell distribution width as a sensitive biomarker for assessing the pulmonary function in automobile welders-a cross sectional study[J].J Clin Diagn Res,2013,7(1):89-92.
[20]王金艳,洪波,孙珍贵,等.红细胞分布宽度与慢性阻塞性肺疾病继发肺动脉高压的相关性研究[J].国际呼吸杂志,2014,34(17):1301-1303.
[2]孙星河,杜昕.红细胞分布宽度——易被忽视的预后标志物[J].心肺血管病杂志,2014,33(3):449-452.
[3]何磊.红细胞分布宽度的临床应用系新进展[J].医学综述,2013,19(1):135-137.
[4]Wang W,Liu J,Yang YH,et al.Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension[J].Clin Respir J,2016,10(1):54-60.
[5]李震南,柳志红,顾晴,等.红细胞分布宽度与特发性肺动脉高压病情和预后的相关性分析[J].中国循环杂志,2013,28(2):111-114.
[6]Xi Q,Liu Z,Zhao Z,et al.Red blood cell distribution width predicts responsiveness of acute pulmonary vasodilator testing in patients with idiopathic pulmonary arterial hypertension[J].Clin Chim Acta,2015,446:272-276.
[7]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[8]López-Candales A,Dohi K,Rajagopalan N,et al.Defining normal variables of right ventricular size and function in pulmonary hypertension:an echocardiographic study[J].Postgrad Med J,2008,84(987):40-45.
[9]王新房,谢明星,邓又斌,等.超声心动图学[M].4版.北京:人民卫生出版社,2009:606-612.
[10]刘雪,王珂,丛涛,等.右心室等容收缩期心肌加速度与肺动脉压力的相关性研究[J].大连医科大学学报,2015,37(5):480-483.
[11]Horne BD.A changing focus on the red cell distribution width:why does it predict mortality and other adverse medical outcomes?[J].Cardiology,2012,122(4):213-215.
[12]朱帅俊,陈冬梅,何鑫敏,等.氦-氧机械通气在慢性阻塞性肺疾病急性加重期的作用[J].河北医科大学学报,2016,37(5):523-527.
[13]Tsuboi S,Miyauchi K,Kasai T,et al.Impact of red blood cell distribution width on long-term mortality in diabetic patients after percutaneous coronary intervention[J].Circ J,2013,77(2):456-461.
[14]李慧芬,赵家慧.低分子肝素钙与肝素治疗AECOPD呼吸衰竭的效果及对PEFR的影响[J].河北医科大学学报,2016,37(8):957-960.
[15]Kurto4lu E,Aktürk E,Korkmaz H,et al.Elevated red blood cell distribution width in healthy smokers[J].Turk Kardiyolo Dern Ars,2013,41(3):199-206.
[16]Seyhan EC,zgül MA,Tutar N,et al.Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease[J].COPD,2013,10(4):416-424.
[17]Balta S,Aydogan M,Demirkol S,et al.Red cell distribution width:a novel and simple predictor of mortality in chronic obstructive pulmonary disease[J].COPD,2014,11(4):475-476.
[18]Wang W,Liu J,Yang YH,et al.Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension[J].Clin Respir J,2016,10(1):54-60.
[19]Subhashree AR,Shanthi B,Parameaswari PJ.The red cell distribution width as a sensitive biomarker for assessing the pulmonary function in automobile welders-a cross sectional study[J].J Clin Diagn Res,2013,7(1):89-92.
[20]王金艳,洪波,孙珍贵,等.红细胞分布宽度与慢性阻塞性肺疾病继发肺动脉高压的相关性研究[J].国际呼吸杂志,2014,34(17):1301-1303.