红细胞体积分布宽度对心力衰竭患者病情及预后转归的评估价值
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摘要
目的:研究红细胞体积分布宽度(RDW)对心力衰竭患者病情及预后转归的评估价值。方法:将我院心内科收治的110例心力衰竭患者(研究组)根据病情分为NYHAⅡ级30例、Ⅲ级46例、Ⅳ级34例,另选择同期健康体检者110例作为对照组。同时根据患者6个月内预后情况分为存活组(91例)和死亡组(19例)。比较分析各组患者RDW水平、死亡率,采用单因素和多因素logistic回归分析心力衰竭预后的影响因素。结果:研究组中,NYHAⅢ~Ⅳ级患者RDW水平明显高于对照组,且随着NYHA分级的增加,RDW水平明显升高(P<0.05)。NYHAⅣ级患者死亡率明显高于NYHAⅡ、Ⅲ级患者(P<0.05)。与死亡组比较,存活组年龄明显较小,入院时Hcy、CRP、GLU、RDW、NT-pro BNP明显降低,Hb、RBC、LVEF水平明显升高(P <0.05)。年龄、入院时NT-pro BNP和RDW是心力衰竭的独立危险因素,而LVEF水平是独立保护因素(P<0.05)。结论:RDW可反映心力衰竭患者的病情严重程度,对于预后转归评估具有重要指导意义。
Objective: To explore the evaluation value of red blood cell distribution width(RDW) on severity and prognosis of patients with heart failure. Methods: According to the severity of disease, 110 cases of heart failure patients(research group) who admitted in the department of cardiology of our hospital were divided into different grades, including 30 patients of NYHA Ⅱ, 46 patients of NYHA Ⅲ, 34 patients of NYHA Ⅳ. At the same time, 110 cases of physical examination were selected as the control group. All the patients were also divided into the survival group(n=91) and the death group(n=19) according to the prognosis within 6 months. The RDW and mortality were compared among the groups, univariate analysis and multivariate logistic analysis were performed to assess the influencing factors of heart failure. Results: The RDW level in NYHA Ⅲ~Ⅳ of research group were significantly lower than that of the control group, and with the increase of NYHA classification, the RDW level was significantly increased(P<0.05). Compared with the death group, the age in survival group was obviously younger, the levels of Hcy, CRP, GLU, RDW, NT-pro BNP on admission were significantly decreased, the LVEF level was significantly increased(P<0.05). Logistic regression analysis showed that age, NT-pro BNP,RDW on admission were independent risk factors of heart failure, and LVEF was independent protection factor(P<0.05). Conclusions:RDW can reflect the severity of heart failure, it has important guiding meaning for the prognosis evaluation of patients with heart failure.
Objective: To explore the evaluation value of red blood cell distribution width(RDW) on severity and prognosis of patients with heart failure. Methods: According to the severity of disease, 110 cases of heart failure patients(research group) who admitted in the department of cardiology of our hospital were divided into different grades, including 30 patients of NYHA Ⅱ, 46 patients of NYHA Ⅲ, 34 patients of NYHA Ⅳ. At the same time, 110 cases of physical examination were selected as the control group. All the patients were also divided into the survival group(n=91) and the death group(n=19) according to the prognosis within 6 months. The RDW and mortality were compared among the groups, univariate analysis and multivariate logistic analysis were performed to assess the influencing factors of heart failure. Results: The RDW level in NYHA Ⅲ~Ⅳ of research group were significantly lower than that of the control group, and with the increase of NYHA classification, the RDW level was significantly increased(P<0.05). Compared with the death group, the age in survival group was obviously younger, the levels of Hcy, CRP, GLU, RDW, NT-pro BNP on admission were significantly decreased, the LVEF level was significantly increased(P<0.05). Logistic regression analysis showed that age, NT-pro BNP,RDW on admission were independent risk factors of heart failure, and LVEF was independent protection factor(P<0.05). Conclusions:RDW can reflect the severity of heart failure, it has important guiding meaning for the prognosis evaluation of patients with heart failure.
引文
[1] Yang HJ, Liu X, Qu C, et al. Usefulness of Red Blood Cell Distribution Width to Predict Heart Failure Hospitalization in Patients with Hypertrophic Cardiomyopathy[J]. Int Heart J, 2018, 59(4):779-785
[2] Czarnywojtek A, Sawicka-Gutaj N, Miechowicz I, et al. Red cell distribution width-a new marker for exacerbation of heart failure in patients with hypothyroidism following radioiodine therapy[J].Endokrynol Pol, 2018, 69(3):235-240
[3] Sotiropoulos K, Yerly P, Monney P, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction[J]. ESC Heart Fail, 2016, 3(3):198-204
[4]卢亚亨,王献民,郭永宏,等.红细胞分布宽度在儿童急性心力衰竭严重程度评估中的价值[J].中华实用儿科临床杂志, 2017, 32(1):38-40
[5]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志, 2014, 42(2):3-10
[6] Kucera M, Balaz D, Kruzliak P, et al. The effects of atorvastatin treatment on the mean platelet volume and red cell distribution width in patients with dyslipoproteinemia and comparison with plasma atherogenicity indicators-a pilot study[J]. Clin Biochem, 2015, 48(9):557-561
[7] Lippi G, Sanchis-Gomar F, Danese E, et al. Association of red blood cell distribution width with plasma lipids in a general population of unselected outpatients[J]. Kardiol Pol, 2013, 71(9):931-936
[8] Felker GM, Allen LA, Pucock SJ, el a1. Red cell distribution width as a novel prognostic marker in heart failure:data from the CHARM Program and the Duke Databank[J]. J Am Coil Cardiol, 2007, 50(1):40-47
[9] Lippi G, Turcato G, Cervellin G, et al. Red blood cell distribution width in heart failure:A narrative review[J]. World J Cardiol, 2018,10(2):6-14
[10] Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width:A simple parameter with multiple clinical applications[J]. Crit Rev Clin Lab Sci, 2015, 52(23):86-105
[11] Lippi G, Pavesi F, Bardi M, et al. Lack of harmonization of red blood cell distribution width(RDW). Evaluation of four hematological analyzers[J]. Clin Biochem, 2014, 47(23):1100-1103
[12] Xanthopoulos A, Giamouzis G, Melidonis A, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovasc Diabetol, 2017, 16(1):81-86
[13] Imai R, Uemura Y, Okumura T, et al. Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction[J]. J Cardiol, 2017, 70(6):591-597
[14] Nú觡ez J, Nú觡ez E, Rizopoulos D, et al. Red blood cell distribution width is longitudinally associated with mortality and anemia in heart failure patients[J]. Circ J, 2014, 78(12):410-418
[15] Muhlestein JB, Lappe DL, Anderson JL, et al. Both initial red cell distribution width(RDW)and change in RDW during heart failure hospitalization are associated with length of hospital stay and 30-day outcomes[J]. Int J Lab Hematol, 2016, 38(2):328-337
[16] Xanthopoulos A, Giamouzis G, Melidonis A, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovasc Diabetol, 2017, 16(22):81-90
[17] Meta-analysis Global Group in Chronic Heart Failure(MAGGIC).The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction:an individual patient data metaanalysis[J]. Eur Heart J, 2012, 33(8):1750-1757
[18] Turcato G, Zorzi E, Prati D, Ricci G, et al. Early in-hospital variation of red blood cell distribution width predicts mortality in patients with acute heart failure[J]. Int J Cardiol, 2017, 243(4):306-310
[19] Huang YL, Hu ZD, Liu SJ, et al. Prognostic value of red blood cell distribution width for patients with heart failure:a systematic review and meta-analysis of cohort studies[J]. PLoS One, 2014, 9(23):e104861
[20]王彬,李拥军.红细胞体积分布宽度在心力衰竭疾病应用中的研究进展[J].现代中西医结合杂志, 2013, 22(7):792-794
[2] Czarnywojtek A, Sawicka-Gutaj N, Miechowicz I, et al. Red cell distribution width-a new marker for exacerbation of heart failure in patients with hypothyroidism following radioiodine therapy[J].Endokrynol Pol, 2018, 69(3):235-240
[3] Sotiropoulos K, Yerly P, Monney P, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction[J]. ESC Heart Fail, 2016, 3(3):198-204
[4]卢亚亨,王献民,郭永宏,等.红细胞分布宽度在儿童急性心力衰竭严重程度评估中的价值[J].中华实用儿科临床杂志, 2017, 32(1):38-40
[5]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志, 2014, 42(2):3-10
[6] Kucera M, Balaz D, Kruzliak P, et al. The effects of atorvastatin treatment on the mean platelet volume and red cell distribution width in patients with dyslipoproteinemia and comparison with plasma atherogenicity indicators-a pilot study[J]. Clin Biochem, 2015, 48(9):557-561
[7] Lippi G, Sanchis-Gomar F, Danese E, et al. Association of red blood cell distribution width with plasma lipids in a general population of unselected outpatients[J]. Kardiol Pol, 2013, 71(9):931-936
[8] Felker GM, Allen LA, Pucock SJ, el a1. Red cell distribution width as a novel prognostic marker in heart failure:data from the CHARM Program and the Duke Databank[J]. J Am Coil Cardiol, 2007, 50(1):40-47
[9] Lippi G, Turcato G, Cervellin G, et al. Red blood cell distribution width in heart failure:A narrative review[J]. World J Cardiol, 2018,10(2):6-14
[10] Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width:A simple parameter with multiple clinical applications[J]. Crit Rev Clin Lab Sci, 2015, 52(23):86-105
[11] Lippi G, Pavesi F, Bardi M, et al. Lack of harmonization of red blood cell distribution width(RDW). Evaluation of four hematological analyzers[J]. Clin Biochem, 2014, 47(23):1100-1103
[12] Xanthopoulos A, Giamouzis G, Melidonis A, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovasc Diabetol, 2017, 16(1):81-86
[13] Imai R, Uemura Y, Okumura T, et al. Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction[J]. J Cardiol, 2017, 70(6):591-597
[14] Nú觡ez J, Nú觡ez E, Rizopoulos D, et al. Red blood cell distribution width is longitudinally associated with mortality and anemia in heart failure patients[J]. Circ J, 2014, 78(12):410-418
[15] Muhlestein JB, Lappe DL, Anderson JL, et al. Both initial red cell distribution width(RDW)and change in RDW during heart failure hospitalization are associated with length of hospital stay and 30-day outcomes[J]. Int J Lab Hematol, 2016, 38(2):328-337
[16] Xanthopoulos A, Giamouzis G, Melidonis A, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovasc Diabetol, 2017, 16(22):81-90
[17] Meta-analysis Global Group in Chronic Heart Failure(MAGGIC).The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction:an individual patient data metaanalysis[J]. Eur Heart J, 2012, 33(8):1750-1757
[18] Turcato G, Zorzi E, Prati D, Ricci G, et al. Early in-hospital variation of red blood cell distribution width predicts mortality in patients with acute heart failure[J]. Int J Cardiol, 2017, 243(4):306-310
[19] Huang YL, Hu ZD, Liu SJ, et al. Prognostic value of red blood cell distribution width for patients with heart failure:a systematic review and meta-analysis of cohort studies[J]. PLoS One, 2014, 9(23):e104861
[20]王彬,李拥军.红细胞体积分布宽度在心力衰竭疾病应用中的研究进展[J].现代中西医结合杂志, 2013, 22(7):792-794