红细胞分布宽度变化在慢性心力衰竭患者预后的运用价值

目的：探讨外周血红细胞分布宽度( RDW)变化对慢性心力衰竭( CHF)住院患者预后的影响。方法选择阳春市中医院于2015年8月至2016年4月收治的慢性心力衰竭住院患者共120例为研究对象。根据患者NYHA心功能分级,分为轻度衰竭组78例(轻度组,心功能分级Ⅰ、Ⅱ级)、重度衰竭组42例(重度组,心功能分级Ⅲ、Ⅳ级)；根据RDW分为异常组43例( RDW>15.5)、正常组77例( RDW<15.5)。比较轻度组与重度组血红蛋白( Hb)浓度、红细胞计数( RBC)、血细胞比容( Hct)、RDW、LVEF等指标,并记录RDW异常组与正常组住院期间恶性心律失常、心力衰竭加重(反复)、病死率等情况。结果轻度组Hb、RBC、Hct、LVEF、RDW分别为(137.35±18.23)g/L、(4.40±0.38)×1012/L、(40.64±6.45)％、(58.17±5.82)％、(13.06±1.12),与重度组差异均有统计学意义(t=5.286、4.179、3.928、6.734、4.206,P<0.05)。 RDW异常组住院期间恶性心律失常、心力衰竭加重或反复及住院期间死亡率分别为34.88％(15/43)、46.51％(20/43)、11.63％(5/43),均显著高于RDW正常组(χ2=23.653、32.343、4.096, P<0.05)。结论相比于轻度慢性心力衰竭患者,重度心力衰竭患者Hb、RBC、Hct、LVEF、RDW等指标表现更差。 RDW异常者住院期间恶性心律失常、心力衰竭加重或反复及住院期间死亡率均高于RDW正常者。 RDW与慢性心力衰竭患者预后有一定的联系。

Application value of red blood cell distribution width in the prognosis of chronic heart failure patients

Objective To explore the influence of red blood cell distribution width ( RDW) in the prognosis of chronic heart failure ( CHF) inpatient. Methods A total of 120 chronic heart failure in-patients received in Yang-chun Hospital of Traditional Chinese Medicine from August 2015 to April 2016 were selected as the research objects. According to the cardiac functional grading of NYHA, these in-patients were divided into mild failure group at 78 ( mild group, cardiac functional grading I and II), severe failure group at 42 in-patients (severe group, cardiac functional grading III and IV). According to RDW, the inpatients were divided into abnormal group at 43 (RDW>15. 5) and nor-mal group at 77 (RDW<15. 5). The indices such as hemoglobin (Hb) concentration, red blood cell count (RBC), haematocrit ( Hct) , RDW and LVEF of mild group were compared with it of severe group. In addition, during the hos-pital stay, the malignant arrhythmia, cardiac failure exacerbation ( recurrent) and case fatality rate of red blood cell dis-tribution width abnormal group were compared with normal group. Results The Hb, RBC, Hct, LVEF and RDW of mild group were respectively ( 137. 35 ± 18. 23 ) g/L, ( 4. 40 ± 0. 38 ) × 1012/L, ( 40. 64 ± 6. 45 )%, ( 58. 17 ± 5. 82 )% and ( 13. 06 ± 1. 12 ) . The difference from severe group had statistical significance ( t=5. 286 , 4. 179 , 3. 928, 6. 734, 4. 206, P<0. 05). During the hospital stay, malignant arrhythmia and cardiac failure of red blood cell distribution width abnormal group were worsened or recurrent, and the death rates were 34. 88% ( 15/43 ) , 46. 51%(20/43) and 11. 63% (5/43) during the hospital stay, which were significantly higher than that of the normal group (χ2=23. 653, 32. 343, 4. 096, P<0. 05). Conclusion Compared with mild and chronic heart failure patients, the indices such as Hb, RBC, Hct, LVEF and RDW of the severe group are worse. During the hospital stay, malignant ar-rhythmia and heart failure of RDW abnormal group are worsened or recurrent, and the death rates are significantly higher than normal group. RDW must be correlated with the prognosis of chronic heart failure patients.