红细胞分布宽度在心力衰竭患者病情和预后评估中的意义
|
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。
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.
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。
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.
引文
1. Swedberg K, Cleland J, Dargie H, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J. 2005,26:1115-40
2.中华医学会心血管病学分会;中国部分地区1980、1990、2000年慢性心力衰竭住院病例回顾性调查;中华心血管病杂志。2002,30:450-454
3. Felker GM, Allen LA.,Pocock SJ, et al.Red cell distribution wideth as a novel prognostic maker in heart failure:data from the CHARM Program and Duke Databank .J Am Coll cardiol 2007,50:40-7
4. Evant TC,Jehle D. The red blood cell distribution wideth . J Emerg Med 1991,9:71-4.(Review)
5.陈俊华,董先杰,刘勇,慢性心力衰竭患者中红细胞分布宽度与心功能的关系[J].临床心血管病杂志,2009,25:155-61
6.吴楚财,张慧,罗诩芝等,红细胞分布宽度对慢性心力衰竭预后的影响[J].广东医学,2009,30:456-8
7. Van Zeben D, Bieger R, Van Wermeskerken RK, et al. Evaluation of microcytosis using serum ferritin and red blood cell distribution wideth . Eur J Haematol 1990,44:106-9
8. Aslan D,Gumruk F, Gurgey A, et al. Importance of RDW value in differential diagnosis of hypochrome anemias. Am J Hematol 2002,69:31-3
9. Duffy T P. Approach to the patient with anemia [M]//Kelley W N,Duponthl,GlickjhJ H,eds.Kelley’s textbook of internal medicine. 3rd ed. Philadelphia: Lippincott Williams and Wilkins,1997:p1295-1299
10. F?rhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis,inflammation, renal function, and nutritional state. Am Heart J 2009,158:659-66.
11. Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 2009,11:840-6
12. Tonelli M ,Sacks F, Arnold M,Moye L, et al. For the cholesterol and Reccurent Events(CARE) Trial Investigators.Relation Between Red Blood Cell Distribution Wideth and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008,117:163-8
13. Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009,277:103-8
14. Hampole CV, Mehrotra AK, Thenappan T, et al. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009,104:868-72
15. Perlstein TS, Weuve J, Pfeffer MA, et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009,169:588-94
16. Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009,169:515-23
17. Groerming BA,Raymod l,Hildebrandt PR,et a1.Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro—brain natriuretic peptide concentrations in a large sample of the general population [J].Heart,2004,90:297-303
18. Gustasaon F, Farand SH,Badskjer J, et a1.Diagnostic and prognostic performance of N-terminal proBNP in primary care patients with suspected heart failure[J].J Card Fail,2005,11:15-20
19. Bettencourt P,Azevedo A,Pimenta J,et a1.N-terminal-pro-brain natriuretic peptide pridicts outcome after hospital discharge in heart failure patients [J]. Circulation,2004,l10:2168-2178
20. Hartmann F,Packer M,Coats A, et a1.Prognosis impact of plasma N—terminal pro—brain natriuretic peptide in severe chronic congestive heart failure [J]. Circulation , 2004,l10:1780
21. Duckelmann C,Mittermayer F,Haider DG,et a1.Asymmetric dimethylarginine enhances cardiovascular risk prediction in patients with chronic heart failure [J] Arterioscler Thromb Vase Biol,2007,27:l-7
22. Richards AM,Doughty R,Nicholls GM,et a1.Plasma N—terminal pro-brain natriuretic peptide and adrenomedullin[J].J Am Coll Cardiol,2001,37:1781-1787.
23. Antoni BG.Rafael V.Teresa P, et a1.Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure[J].Eur J Heart Fail,2007,5:6-l1
24. Spnaroval L ,Toman J, Pospislova J, et al Humoral response in patients with chronic heart failure .[J].Int J Cardiol,1998,65:227-232
25. Pierce CN, Larson DF, Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device .Perfusion 2005,20:83-90
26. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic Pedtide but not C-reactive protein are associated with higher red cell distribution wideth in patients with coronary artery disease. Int Heart J. 2009,50:301-12
27. Vlahakos DV, Kosmas EN, Dimopoulou I, et al .Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronic obstrctive pulmonary disease .Am J Med 1999,106:158-64
28. Biaggioni I, Robertson D, Krantz S, et al.. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med 1994,121:181-6
29. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009,133:628-32
30. Ljungman S,Kjekshus J, Swedberg K et al. Renal Function in serve congestive heart failure during treatment with enalapril (the Cooperative North Scandinavian EnalaprilSurvival Study [CONSENSUS] Trial). Am J Cardiol .1992,70:479-487
31. Dries DL, Exner DV, Domanski MJ, et al .The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction . J Am Coll Cardiol .2000,35:681-689
32. Hillege HL, Girbes AR, de Kam PJ , et al .Renal function, neurohormonal activation and survival in patients with chromic heart failure .Circulation .2000,102:203-210
33. Ruilope LM, Van Veldhuisen DJ, Ritz E, et al. Renal function: the Cinderella of cardiovascular risk profile .J Am Coll Cardiol .2001;38:1782-1787
34. Al Ahmad A, Rand WM,Manjunath G, et al. Reduced kidney function and anemia as risk factors for mortiality in patients with left ventricular dysfunction. J Am Coll Cardiol .2001,38:955 -962
35. Mahon NG, Blackstone EH, Francis GS, et al .The prognostic value of estimated creatinine clearance alongside functional capacity in ambulatory patients with chronic congestive heart failure. J Am Coll Cardiol .2002,40:1106 -1113
36. Sarnak MJ, Levey AS, Schoolwerth AC, et al .Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease ,High Blood Pressure Research ,Clinical Cardiology, and Epidemiology and Prevention. Circulation.2003,108:2154-2169
37. Hillege HL,van Gilst WH, Van Veldhusien DJ, et al. Accelerated decline. and prognostic impact of renal function after myocardial infraction and the benefits of ACE inhibition:the CATS randomized trial. Eur Heart J.2003,244:12-420
38. Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infraction .N Engl J Med .2004,351:1285-1295
39. Jones RC, Francis GS,Lauer MS. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitails Investagation Group Trial. J Am Coll Cardiol .2004,44:1025 -1029
40. Smilde TD, Hillege HL,Voors AA, et al Prognostic importance of renal function in patients with early heart failure and mild left ventricular dysfunction. Am J Cardiol .2004,94:240 -243
41. 41. McAlister FA, Ezekowitz J, Tonelli M,et al. Renal insufficiency and heart failure : prognostic and therapeutic implication from a prospcetive cohort sudy. Circulation. 2004,109:1004-1009
1 Evant TC,Jehle D. The red blood cell distribution wideth .J Emerg Med 1991,9:71-4.(Review)
2 Van Zeben D, Bieger R, Van Wermeskerken RK, et al. Evaluation of microcytosis using serum ferritin and red blood cell distribution wideth. Eur J Haematol 1990,44:106-9
3 Aslan D, Gumruk F, Gurgey A, et al. Importance of RDW value in differential diagnosis of hypochrome anemias. Am J Hematol 2002,69:31-3
4 DUFFY T P. Approach to the patient with anemia [M]//KELLEY W N,DUPONTHL,GLICKJ H,eds.Kelley’s textbook of internal medicine. 3 rd ed. Philadelphia: Lippincott Williams and Wilkins,1997;p1295-1299
5 Felker GM, Allen LA ,Pocock SJ, et al.Red cell distribution wideth as a novel prognostic maker in heart failure:data from the CHARM Program and Duke Databa nk .J Am Coll Cardiol 2007,50:40-7
6 Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 2009,11:840-6
7 Tonelli M .Sacks F, Arnold M, et al. For the cholesterol and Reccurent Events(CARE) Trial Investigators.Relation Between Red Blood Cell Distribution Wideth and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008,117:163-8
8 Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009,277:103-8
9 Hampole CV, Mehrotra AK, Thenappan T, et al. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009,104:868-72
10 Perlstein TS, Weuve J, Pfeffer MA, et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009,169:588-94
11 Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009,169:515-23
12陈俊华,董先杰,刘勇.慢性心力衰竭患者中红细胞分布宽度与心功能的关系[J].临床心血管病杂志, 2009,25:155-6
13吴楚财,张慧,罗诩芝,等.红细胞分布宽度对慢性心力衰竭预后的影响[J].广东医学,2009,30:456-8
14 Oh J, Kang S,. Hong N, et al. Relation between red cell distribution width with echocardiographic parameters in patients with acute heart failure. J Card Fail 2009,15:517-22.
15 Cavusoglu E, Chopra V, Gupta A, et al. Relation between red cell distribution wideth (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol 2009; Jan 12 [Epub ahead of print]
16 Spnaroval L ,Toman J, Pospislova J, et al Humoral response in patients with chronic heart failure .[J].Int J Cardiol,1998,65:227-232
17 F?rhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009,158:659-66
18 Pierce CN, Larson DF, Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device .Perfusion 2005,20:83-90
19 Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic Pedtide but not C-reactive protein are associated with higher red cell distribution wideth in patients with coronary artery disease. Int Heart J. 2009 ,50:301-12
20 Vlahakos DV, Kosmas EN, Dimopoulou I, et al ,Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronicobstrctive pulmonary disease .Am J Med 1999,106:158-64
21 Biaggioni I, Robertson D, Krantz S, et al. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med 1994,121:181-6
22 Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009,133:628-32
23 Deswal A, Petersen NJ, Feldman AM, et al. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone trial (VEST).Circulation 2001,103:2055-9
24 Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and Kidney function tests in a large cohort of unselected outpatients. J Clinical & Laboratory Investigation 2008, 68:745-48
25 Ljungman S,Kjekshus J, Swedberg K. Renal Function in serve congestive heart failure during treatment with enalapril (the Cooperative North Scandinavian Enalapril Survival Study [CONSENSUS] Trial). Am J Cardiol .1992,70:479-487
26 Dries DL, Exner DV, Domanski MJ ,et al. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol .2000,35:681-689
27 Hillege HL, Girbes AR, de Kam PJ ,et al. Renal function, neurohormonal activation and survival in patients with chronic heart failure .Circulation .2000,102:203-210
28 Ruilope LM, Van Veldhuisen DJ, Ritz E,et al. Renal function : the Cinderella of cardiovascular risk profile .J Am Coll Cardiol .2001,38:1782-1787
29 Al Ahmad A, Rand WM,Manjunath G, et al..Reduced kidney function and anemia as risk factors for mortiality in patients with left ventricular dysfunction. J Am Coll Cardiol .2001,38:955 -962
30 Mahon NG, Blackstone EH, Francis GS,et al .The prognostic value of estimated creatinine clearance alongside functional capacity in ambulatory patients with chronic congestive heart failure . J Am Coll Cardiol .2002,40:1106 -1113
31 Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research ,Clinical Cardiology, and Epidemiology and Prevention. Circulation.2003,108:2154-2169
32 Hillege HL,van Gilst WH, Van Veldhusien DJ, et al. Accelerated decline. and prognostic impact of renal function after myocardial infraction and the benefits of ACE inhibition: the CATS randomized trial . Eur Heart J.2003,244:12-420
33 Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infraction .N Engl J Med .2004,351:1285-1295
34 Jones RC, FrancisGS,Lauer MS. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitails Investagation Group Trial. J Am Coll Cardiol .2004,44:1025 -1029
35 Smilde TD, Hillege HL,Voors AA, et al.Prognostic importance of renal function in patients with early heart failure and mild left ventricular dysfunction. Am J Cardiol .2004,94:240 -243
36 McAlister FA, Ezekowitz J, Tonelli M,et al. Renal insufficiency and heart failure: prognostic and therapeutic implication from a prospcetive cohort sudy. Circulation. 2004,109:1004-1009
2.中华医学会心血管病学分会;中国部分地区1980、1990、2000年慢性心力衰竭住院病例回顾性调查;中华心血管病杂志。2002,30:450-454
3. Felker GM, Allen LA.,Pocock SJ, et al.Red cell distribution wideth as a novel prognostic maker in heart failure:data from the CHARM Program and Duke Databank .J Am Coll cardiol 2007,50:40-7
4. Evant TC,Jehle D. The red blood cell distribution wideth . J Emerg Med 1991,9:71-4.(Review)
5.陈俊华,董先杰,刘勇,慢性心力衰竭患者中红细胞分布宽度与心功能的关系[J].临床心血管病杂志,2009,25:155-61
6.吴楚财,张慧,罗诩芝等,红细胞分布宽度对慢性心力衰竭预后的影响[J].广东医学,2009,30:456-8
7. Van Zeben D, Bieger R, Van Wermeskerken RK, et al. Evaluation of microcytosis using serum ferritin and red blood cell distribution wideth . Eur J Haematol 1990,44:106-9
8. Aslan D,Gumruk F, Gurgey A, et al. Importance of RDW value in differential diagnosis of hypochrome anemias. Am J Hematol 2002,69:31-3
9. Duffy T P. Approach to the patient with anemia [M]//Kelley W N,Duponthl,GlickjhJ H,eds.Kelley’s textbook of internal medicine. 3rd ed. Philadelphia: Lippincott Williams and Wilkins,1997:p1295-1299
10. F?rhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis,inflammation, renal function, and nutritional state. Am Heart J 2009,158:659-66.
11. Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 2009,11:840-6
12. Tonelli M ,Sacks F, Arnold M,Moye L, et al. For the cholesterol and Reccurent Events(CARE) Trial Investigators.Relation Between Red Blood Cell Distribution Wideth and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008,117:163-8
13. Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009,277:103-8
14. Hampole CV, Mehrotra AK, Thenappan T, et al. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009,104:868-72
15. Perlstein TS, Weuve J, Pfeffer MA, et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009,169:588-94
16. Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009,169:515-23
17. Groerming BA,Raymod l,Hildebrandt PR,et a1.Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro—brain natriuretic peptide concentrations in a large sample of the general population [J].Heart,2004,90:297-303
18. Gustasaon F, Farand SH,Badskjer J, et a1.Diagnostic and prognostic performance of N-terminal proBNP in primary care patients with suspected heart failure[J].J Card Fail,2005,11:15-20
19. Bettencourt P,Azevedo A,Pimenta J,et a1.N-terminal-pro-brain natriuretic peptide pridicts outcome after hospital discharge in heart failure patients [J]. Circulation,2004,l10:2168-2178
20. Hartmann F,Packer M,Coats A, et a1.Prognosis impact of plasma N—terminal pro—brain natriuretic peptide in severe chronic congestive heart failure [J]. Circulation , 2004,l10:1780
21. Duckelmann C,Mittermayer F,Haider DG,et a1.Asymmetric dimethylarginine enhances cardiovascular risk prediction in patients with chronic heart failure [J] Arterioscler Thromb Vase Biol,2007,27:l-7
22. Richards AM,Doughty R,Nicholls GM,et a1.Plasma N—terminal pro-brain natriuretic peptide and adrenomedullin[J].J Am Coll Cardiol,2001,37:1781-1787.
23. Antoni BG.Rafael V.Teresa P, et a1.Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure[J].Eur J Heart Fail,2007,5:6-l1
24. Spnaroval L ,Toman J, Pospislova J, et al Humoral response in patients with chronic heart failure .[J].Int J Cardiol,1998,65:227-232
25. Pierce CN, Larson DF, Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device .Perfusion 2005,20:83-90
26. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic Pedtide but not C-reactive protein are associated with higher red cell distribution wideth in patients with coronary artery disease. Int Heart J. 2009,50:301-12
27. Vlahakos DV, Kosmas EN, Dimopoulou I, et al .Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronic obstrctive pulmonary disease .Am J Med 1999,106:158-64
28. Biaggioni I, Robertson D, Krantz S, et al.. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med 1994,121:181-6
29. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009,133:628-32
30. Ljungman S,Kjekshus J, Swedberg K et al. Renal Function in serve congestive heart failure during treatment with enalapril (the Cooperative North Scandinavian EnalaprilSurvival Study [CONSENSUS] Trial). Am J Cardiol .1992,70:479-487
31. Dries DL, Exner DV, Domanski MJ, et al .The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction . J Am Coll Cardiol .2000,35:681-689
32. Hillege HL, Girbes AR, de Kam PJ , et al .Renal function, neurohormonal activation and survival in patients with chromic heart failure .Circulation .2000,102:203-210
33. Ruilope LM, Van Veldhuisen DJ, Ritz E, et al. Renal function: the Cinderella of cardiovascular risk profile .J Am Coll Cardiol .2001;38:1782-1787
34. Al Ahmad A, Rand WM,Manjunath G, et al. Reduced kidney function and anemia as risk factors for mortiality in patients with left ventricular dysfunction. J Am Coll Cardiol .2001,38:955 -962
35. Mahon NG, Blackstone EH, Francis GS, et al .The prognostic value of estimated creatinine clearance alongside functional capacity in ambulatory patients with chronic congestive heart failure. J Am Coll Cardiol .2002,40:1106 -1113
36. Sarnak MJ, Levey AS, Schoolwerth AC, et al .Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease ,High Blood Pressure Research ,Clinical Cardiology, and Epidemiology and Prevention. Circulation.2003,108:2154-2169
37. Hillege HL,van Gilst WH, Van Veldhusien DJ, et al. Accelerated decline. and prognostic impact of renal function after myocardial infraction and the benefits of ACE inhibition:the CATS randomized trial. Eur Heart J.2003,244:12-420
38. Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infraction .N Engl J Med .2004,351:1285-1295
39. Jones RC, Francis GS,Lauer MS. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitails Investagation Group Trial. J Am Coll Cardiol .2004,44:1025 -1029
40. Smilde TD, Hillege HL,Voors AA, et al Prognostic importance of renal function in patients with early heart failure and mild left ventricular dysfunction. Am J Cardiol .2004,94:240 -243
41. 41. McAlister FA, Ezekowitz J, Tonelli M,et al. Renal insufficiency and heart failure : prognostic and therapeutic implication from a prospcetive cohort sudy. Circulation. 2004,109:1004-1009
1 Evant TC,Jehle D. The red blood cell distribution wideth .J Emerg Med 1991,9:71-4.(Review)
2 Van Zeben D, Bieger R, Van Wermeskerken RK, et al. Evaluation of microcytosis using serum ferritin and red blood cell distribution wideth. Eur J Haematol 1990,44:106-9
3 Aslan D, Gumruk F, Gurgey A, et al. Importance of RDW value in differential diagnosis of hypochrome anemias. Am J Hematol 2002,69:31-3
4 DUFFY T P. Approach to the patient with anemia [M]//KELLEY W N,DUPONTHL,GLICKJ H,eds.Kelley’s textbook of internal medicine. 3 rd ed. Philadelphia: Lippincott Williams and Wilkins,1997;p1295-1299
5 Felker GM, Allen LA ,Pocock SJ, et al.Red cell distribution wideth as a novel prognostic maker in heart failure:data from the CHARM Program and Duke Databa nk .J Am Coll Cardiol 2007,50:40-7
6 Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 2009,11:840-6
7 Tonelli M .Sacks F, Arnold M, et al. For the cholesterol and Reccurent Events(CARE) Trial Investigators.Relation Between Red Blood Cell Distribution Wideth and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008,117:163-8
8 Ani C, Ovbiagele B. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 2009,277:103-8
9 Hampole CV, Mehrotra AK, Thenappan T, et al. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009,104:868-72
10 Perlstein TS, Weuve J, Pfeffer MA, et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009,169:588-94
11 Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009,169:515-23
12陈俊华,董先杰,刘勇.慢性心力衰竭患者中红细胞分布宽度与心功能的关系[J].临床心血管病杂志, 2009,25:155-6
13吴楚财,张慧,罗诩芝,等.红细胞分布宽度对慢性心力衰竭预后的影响[J].广东医学,2009,30:456-8
14 Oh J, Kang S,. Hong N, et al. Relation between red cell distribution width with echocardiographic parameters in patients with acute heart failure. J Card Fail 2009,15:517-22.
15 Cavusoglu E, Chopra V, Gupta A, et al. Relation between red cell distribution wideth (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol 2009; Jan 12 [Epub ahead of print]
16 Spnaroval L ,Toman J, Pospislova J, et al Humoral response in patients with chronic heart failure .[J].Int J Cardiol,1998,65:227-232
17 F?rhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009,158:659-66
18 Pierce CN, Larson DF, Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device .Perfusion 2005,20:83-90
19 Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic Pedtide but not C-reactive protein are associated with higher red cell distribution wideth in patients with coronary artery disease. Int Heart J. 2009 ,50:301-12
20 Vlahakos DV, Kosmas EN, Dimopoulou I, et al ,Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronicobstrctive pulmonary disease .Am J Med 1999,106:158-64
21 Biaggioni I, Robertson D, Krantz S, et al. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med 1994,121:181-6
22 Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009,133:628-32
23 Deswal A, Petersen NJ, Feldman AM, et al. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone trial (VEST).Circulation 2001,103:2055-9
24 Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and Kidney function tests in a large cohort of unselected outpatients. J Clinical & Laboratory Investigation 2008, 68:745-48
25 Ljungman S,Kjekshus J, Swedberg K. Renal Function in serve congestive heart failure during treatment with enalapril (the Cooperative North Scandinavian Enalapril Survival Study [CONSENSUS] Trial). Am J Cardiol .1992,70:479-487
26 Dries DL, Exner DV, Domanski MJ ,et al. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol .2000,35:681-689
27 Hillege HL, Girbes AR, de Kam PJ ,et al. Renal function, neurohormonal activation and survival in patients with chronic heart failure .Circulation .2000,102:203-210
28 Ruilope LM, Van Veldhuisen DJ, Ritz E,et al. Renal function : the Cinderella of cardiovascular risk profile .J Am Coll Cardiol .2001,38:1782-1787
29 Al Ahmad A, Rand WM,Manjunath G, et al..Reduced kidney function and anemia as risk factors for mortiality in patients with left ventricular dysfunction. J Am Coll Cardiol .2001,38:955 -962
30 Mahon NG, Blackstone EH, Francis GS,et al .The prognostic value of estimated creatinine clearance alongside functional capacity in ambulatory patients with chronic congestive heart failure . J Am Coll Cardiol .2002,40:1106 -1113
31 Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research ,Clinical Cardiology, and Epidemiology and Prevention. Circulation.2003,108:2154-2169
32 Hillege HL,van Gilst WH, Van Veldhusien DJ, et al. Accelerated decline. and prognostic impact of renal function after myocardial infraction and the benefits of ACE inhibition: the CATS randomized trial . Eur Heart J.2003,244:12-420
33 Anavekar NS, McMurray JJ, Velazquez EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infraction .N Engl J Med .2004,351:1285-1295
34 Jones RC, FrancisGS,Lauer MS. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitails Investagation Group Trial. J Am Coll Cardiol .2004,44:1025 -1029
35 Smilde TD, Hillege HL,Voors AA, et al.Prognostic importance of renal function in patients with early heart failure and mild left ventricular dysfunction. Am J Cardiol .2004,94:240 -243
36 McAlister FA, Ezekowitz J, Tonelli M,et al. Renal insufficiency and heart failure: prognostic and therapeutic implication from a prospcetive cohort sudy. Circulation. 2004,109:1004-1009