红细胞分布宽度与急性心肌梗死的相关性研究
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摘要
目的讨论红细胞分布宽度(red blood cell distribution width,RDW)与急性心肌梗死(acute myocardial infarction,AMI)患者中冠状动脉病变严重程度的关系。方法回顾性分析本院已确诊为AMI的病例,根据入院时心电图ST段抬高与否,分为急性ST段抬高型心肌梗死组(acute ST-segment elevation myocardial infarction,STEMI)和急性非ST段抬高型心肌梗死组(acute non-ST-segment elevation myocardial infarction,NSTEMI),根据患者一般临床资料及冠状动脉造影结果,对其进行分析比较。结果共纳入160例病例,其中对照组40例,STEMI组68例,NSTEMI组52例,NSTEMI组与冠脉正常组间RDW水平及中性粒细胞/淋巴细胞比值(N/L比值)差异具有统计学意义(P<0.05);STEMI组的甘油三酯、RDW、N/L比值均高于冠脉正常组,差异具有统计学意义(P<0.05);STEMI组Gensini评分相对NSTEMI组高,差异具有统计学意义(P<0.05)。RDW水平与Gensini评分、N/L比值、血小板分布宽度(platelet distribution width,PDW)水平呈正相关,与估算肾小球滤过率(estimated glomerular filtration rate,e GFR)、血小板平均体积(meam platelet volume,MPV)水平呈负相关(P<0.05)。结论RDW水平越高则冠脉病变程度越重,RDW具有预测冠脉病变严重程度的重要价值,有望为AMI患者的早期识别、危险分层等提供重要的依据,同时为AMI发生发展的潜在炎症途径提供一定的理论依据。
Objective Aim to evaluated the relation between red blood cell distribution width( RDW) and the severity of coronary artery disease in patients with acute myocardial infarction( AMI). Methods We analyzed retrospectively the patients who have been diagnosed with AMI,then according to the ST-segment elevation or not,cases were classified into two groups,acute ST-segment elevation myocardial infarction( STEMI) and acute non-ST-segment elevation myocardial infarction( NSTEMI). And we made a comparison based on the clinical information and coronary angiographic results. Results A total of 160 cases were included in the study containing 40 control cases,68 STEMI cases and 52 NSTEMI cases. There was significant difference of RDW level and N/L ratio between NSTEMI and control groups( P < 0. 05). There were significant differences of triglyceride,RDW,N/L ratio between STEMI and control groups( P < 0. 05). Patients in STEMI groups had higher Gensini score( P < 0. 05). The RDW values was positively correlated with Gensini score,N/L ratio,PDW level( P < 0. 05) and negatively correlated with e GFR,MPV level( P < 0. 05). Conclusion The RDW values increased with the worse of the severity of coronary artery stenosis,which is predictably meaningful. RDW level may be a new marker for early identification and risk stratification in patients with AMI. Meanwhile,some theoretical basis can be provided for the potential inflammation related mechanism in AMI.
Objective Aim to evaluated the relation between red blood cell distribution width( RDW) and the severity of coronary artery disease in patients with acute myocardial infarction( AMI). Methods We analyzed retrospectively the patients who have been diagnosed with AMI,then according to the ST-segment elevation or not,cases were classified into two groups,acute ST-segment elevation myocardial infarction( STEMI) and acute non-ST-segment elevation myocardial infarction( NSTEMI). And we made a comparison based on the clinical information and coronary angiographic results. Results A total of 160 cases were included in the study containing 40 control cases,68 STEMI cases and 52 NSTEMI cases. There was significant difference of RDW level and N/L ratio between NSTEMI and control groups( P < 0. 05). There were significant differences of triglyceride,RDW,N/L ratio between STEMI and control groups( P < 0. 05). Patients in STEMI groups had higher Gensini score( P < 0. 05). The RDW values was positively correlated with Gensini score,N/L ratio,PDW level( P < 0. 05) and negatively correlated with e GFR,MPV level( P < 0. 05). Conclusion The RDW values increased with the worse of the severity of coronary artery stenosis,which is predictably meaningful. RDW level may be a new marker for early identification and risk stratification in patients with AMI. Meanwhile,some theoretical basis can be provided for the potential inflammation related mechanism in AMI.
引文
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[25]BOZAN N,ALPAYCI M,ASLAN M,et al.Mean platelet volume,red cell distribution width,platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in patients with ankylosing spondylitis and their relationships with high-frequency hearing thresholds[J].European archives of oto-rhino-laryngology:official journal of the European Federation of Oto-Rhino-Laryngological Societies(EUFOS):affiliated with the German Society for OtoRhino-Laryngology-Head and Neck Surgery,2016,273(11):3663-3672.
[26]MURAT S N,DURAN M,KALAY N,et al.Relation between mean platelet volume and severity of atherosclerosis in patients with acute coronary syndromes[J].Angiology,2013,64(2):131-136.
[2]SENTHONG V,HUDEC T,NEALE S,et al.Relation of Red Cell Distribution Width to Left Ventricular End-Diastolic Pressure and Mortality in Patients With and Without Heart Failure[J].The American journal of cardiology,2017,119(9):1421-1427.
[3]M T,F S,M A,et al.Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease[J].Circulation,2008,117(2):163.
[4]DANESE E,LIPPI G,MONTAGNANA M.Red blood cell distribution width and cardiovascular diseases[J].Journal of thoracic disease,2015,7(10):E402-411.
[5]DABBAH S,HAMMERMAN H,MARKIEWICZ W,et al.Relation Between Red Cell Distribution Width and Clinical Outcomes After Acute Myocardial Infarction[J].Chinese Journal of Health Laboratory Technology,2011,105(3):312-317.
[6]VAN KIMMENADE R R,MOHAMMED A A,UTHAMALINGAM S,et al.Red blood cell distribution width and 1-year mortality in acute heart failure[J].European journal of heart failure,2010,12(2):129-136.
[7]GMALLEN F.Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure:Data From the CHARM Program and the Duke Databank[J].Journal of the American College of Cardiology,2007,50(1):40.
[8]ALLEN L A,FELLER G M,MEHRA MR,et al.Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure[J].J Card Fail,2010,16(3):230-238.
[9]YE Z,SMITH C,KULLO I J.Usefulness of Red Cell Distribution Width to Predict Mortality in Patients with Peripheral Artery Disease[J].American Journal of Cardiology,2011,107(8):1241-1245.
[10]ZORLU A,BEKTASOGLU G,GUVEN F M K,et al.Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism[J].American Journal of Cardiology,2012,109(1):128.
[11]SERRUYS P W,ONUMA Y,GARG S,et al.Assessment of the SYNTAX score in the Syntax study[J].Eurointervention Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology,2009,5(1):50.
[12]COCKCROFT D W,GAULT M H.Prediction of creatinine clearance from serum creatinine[J].Nephron,1976,16(1):31-41.
[13]ISIK T,UYAREL H,TANBOGA I H,et al.Relation of red cell distribution width with the presence,severity,and complexity of coronary artery disease[J].Coron Artery Dis,2012,23(1):51-56.
[14]UYAREL H,ERGELEN M,CICEK G,et al.Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction[J].Coronary Artery Disease,2011,22(3):138.
[15]AZAB B,TORBEY E,HATOUM H,et al.Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction[J].Cardiology,2011,119(2):72.
[16]DABBAH S,HAMMERMAN H,MARKIEWICZ W,et al.Relation between red cell distribution width and clinical outcomes after acute myocardial infarction[J].The American journal of cardiology,2010,105(3):312-317.
[17]TRACEY K J,WEI H,MANOGUE K R,et al.Cachectin/tumor necrosis factor induces cachexia,anemia,and inflammation.J.Exp.Med.167,1211-1227[J].Journal of Experimental Medicine,1988,167(3):1211-1227.
[18]SHIN D Y,CHUNG J,JOE Y,et al.Pretreatment with CO-releasing molecules suppresses hepcidin expression during inflammation and endoplasmic reticulum stress through inhibition of the STAT3and CREBH pathways[J].Blood,2012,119(11):2523-2532.
[19]KOENIG W.High-sensitivity C-reactive protein and atherosclerotic disease:from improved risk prediction to risk-guided therapy[J].Int J Cardiol,2013,168(6):5126-5134.
[20]PATEL K V,FERRUCCI L,ERSHLER W B,et al.Red blood cell distribution width and the risk of death in middle-aged and older adults[J].Archives of Internal Medicine,2009,169(5):515.
[21]HILZENDEGER A M,MORAIS R L,TODIRAS M,et al.Leptin regulates ACE activity in mice[J].Journal of molecular medicine(Berlin,Germany),2010,88(9):899-907.
[22]KIM Y C,MUNGUNSUKH O,MCCART E A,et al.Mechanism of erythropoietin regulation by angiotensin II[J].Molecular pharmacology.2014,85(6):898-908.
[23]BROWN J E,ADAMSON J W.Modulation of in vitro erythropoiesis.The influence of beta-adrenergic agonists on erythroid colony formation[J].Journal of Clinical Investigation,1977,60(1):70-77.
[24]WEN Y.High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension[J].Experimental&Clinical Cardiology,2010,15(3):37-40.
[25]BOZAN N,ALPAYCI M,ASLAN M,et al.Mean platelet volume,red cell distribution width,platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in patients with ankylosing spondylitis and their relationships with high-frequency hearing thresholds[J].European archives of oto-rhino-laryngology:official journal of the European Federation of Oto-Rhino-Laryngological Societies(EUFOS):affiliated with the German Society for OtoRhino-Laryngology-Head and Neck Surgery,2016,273(11):3663-3672.
[26]MURAT S N,DURAN M,KALAY N,et al.Relation between mean platelet volume and severity of atherosclerosis in patients with acute coronary syndromes[J].Angiology,2013,64(2):131-136.