慢性心力衰竭患者红细胞分布宽度与心功能的关系及对近期预后的预测价值

目的探讨红细胞分布宽度(RDW)与慢性心力衰竭NYHA心功能的关系及对住院死亡的预测价值。方法收集300例心力衰竭住院患者临床资料,分别依据住院期间预后、NYHA分级、原发心脏疾病以及患者RDW四分位数分组。采用单因素分析、多因素Cox分析、相关性分析和ROC曲线对慢性心力衰竭患者红细胞分布宽度与心功能的关系及对近期预后的预测价值进行分析。结果不同NYHA分级组RDW、LVEDD、LVEF均有显著性差异(P均<0.05),且RDW与NYHA分级、LVEDD、LVEF分别呈正相关、正相关和负相关(P均<0.05)。RDW值四分位分组A组、B组、C组及D组住院死亡率分别为20.00%、19.74%、26.76%、30.14%,差异均有显著性(P<0.05)。将之设定为A级、B级、C级、D级带入多因素Cox回归方程,C级和D级是心力衰竭患者住院死亡危险因素(P均<0.05),以A级为对照,B级、C级和D级死亡风险HR分别为0.869、1.221、1.489。扩张型心肌病组、缺血性心肌病组、风湿性心脏病组、高血压心脏病组RDW为C级及以上住院死亡率分别为57.58%、41.46%、23.53%、41.67%,差异有显著性(P<0.05)。采用ROC曲线分析,全部患者当RDW为14.65%时,对住院死亡的预测敏感性和特异性分别为75.23%、53.26%,曲线下面积为0.672;扩张型心肌病、缺血性心肌病、风湿性心脏病、高血压心脏病患者RDW界值分别为13.55%、13.72%、14.74%、14.63%,差异均有统计学意义(P均<0.05)。结论 RDW与NYHA心功能密切相关,RDW升高是心力衰竭患者住院死亡的独立危险因素,对不同病因心力衰竭患者住院死亡均有预测价值。

Relationship between red blood cell distribution width and cardiac function and predictive significance of short-term prognosis in patients with chronic heart failure

Objective To discuss relationship between red blood cell distribution width（RDW） and cardiac function and predictive significance of short-term prognosis in patients with chronic heart failure（CHF）. Methods Clinical data of 300 cases with CHF were divided difference groups according to short-term prognosis, NYHA, primary disease, RDW quartiles. Relationship between RDW and cardiac function and predictive significance of short-term prognosis in patients with CHF was analyzed by single factor analysis, multiariable Cox analysis, correlation analysis and ROC curve. Results RDW, LVEDD, LVEF showed significant difference in groups of different NYHA（P all＆lt;0.05）. RDW showed positive correlation with NYHA, LVEDD, and negative correlation with LVEF（P all＆lt;0.05）. In-hospital mortality rates of group of A, B, C and D were 20.00%, 19.74%, 26.76%, 30.14%, which showed significant difference（P all＆lt;0.05）. RDW quartiles were set as A, B, C, D degree for multiariable Cox analysis, and results showed C and D degree were risk factors of CHF（P all＆lt;0.05）. Mortality risk HR B, C, D degrees＆amp;nbsp;were 0.869, 1.221, 1.489 compared to that of A degree. In-hospital mortality rate of C and D degrees of DCM, IHD, RHD, HHD were 57.58%, 41.46%, 23.53%, 41.67%, which showed significant difference（P＆lt;0.05）. As RDW was 14.65%, sensibility and specificity of prognosis for in-hospital mortality rates were 75.23%and 53.26%by ROC curve, and AUC was 0.672. RDW of groups of DCM, IHD, RHD, HHD were 13.55%, 13.72%, 14.74%, 14.63%, which showed significant difference （P all＆lt;0.05）. Conclusion RDW shows intimate connection with NYHA cardiac function. RDW increase is risk factor of in-hospital mortality rate in patients with CHF, and shows predictive significance of in-hospital mortality rate.