红细胞分布宽度对不同射血分数的老年急性心力衰竭的预测价值

目的 探讨红细胞分布宽度（RDW）对不同射血分数的老年急性心力衰竭患者分类的诊断价值。方法选取293例老年急性心力衰竭患者，根据左室射血分数（LVEF）不同，分为射血分数减低性心力衰竭（LVEF＜40%）38例（HFrEF组）、射血分数中间性心力衰竭（40%≤LVEF＜50%）74例（HFmrEF组）、射血分数保留性心力衰竭（LVEF≥50%）131例（HFpEF组），同时选取年龄、性别相匹配的无心力衰竭老年人51例作为对照组，收集患者的临床资料，分别检测血常规、生化指标、氨基末端B型钠尿肽原（NT-proBNP）及超声心动图。分析RDW与不同射血分数的老年急性心力衰竭的相关性及诊断意义。结果HFrEF组、HFmrEF组、HFpEF组中RDW值（1442±217)％、(1330±200)％、(1339±247)％,与对照组RDW值(1210±057)％差异有统计学意义（P<005)。RDW与LVEF呈显著负相关(r=-014,P<005)。RDW与NT-proBNP呈显著正相关 (r=013,P<005)。RDW鉴别HFpEF、HFmrEF的受试者工作特征（ROC）曲线下面积（AUC）为059，RDW取值1405%作为界值的敏感度为338%,特异度为829%；RDW鉴别HFrEF、HFmrEF的AUC为062，RDW取值1445%作为界值的敏感度为50%,特异度为76%。结论RDW在老年急性心力衰竭患者中显著升高，并且在HFpEF组、HFmrEF组、HFrEF组中表达各不相同。RDW＜1405%时，诊断HFpEF可能性大；1405%≤RDW≤1445%时，诊断HFmrEF可能性大；RDW＞1445%时，诊断HFrEF可能性大。RDW结合NT-proBNP可作为快速区分不同射血分数类型老年急性心力衰竭的有效指标。

The predictive significance of red blood width in elderly patients with acute heart failure

Objective To investigate the predictive value of red blood cell distribution width (RDW) in different ejection fractions of acute heart failure (AHF) in the elderlies. Methods Hematological , biochemical parameters, B-type natriuretic peptide（NT-proBNP）and ultrasonic cardiogram were obtained from 293 old acute heart failure patients with heart failure with reduced ejection fraction (HFrEF, n=38), heart failure with midlle rage ejection fraction (HFmrEF, n=74), heart failure with preserved ejection fraction (HFpEF, n=131), and 51 elderly patients without heart failure (control group). The correlation and diagnostic value of RDW with different ejection fraction in elderly patients with acute heart failure were analyzed. Results There were significant differences in RDW between the three groups ［(1442±217)%, (1330±200)% and (1339±247)%］ and control group ［(1210±057)%］. There was significant negative correlation between RDW and EF (r=-014, P<005). There was significant positive correlation between RDW and NT-proBNP (r=013, P<005). The area under the curve of RDW to identify HFpEF and HFmrEF was 059; and the sensitivity and specificity were 1405% and 829%, respectively, with the boundary value of 338%. The area under the curve of RDW to identify HFrEF and HFmrEF was 062; and the sensitivity and specificity were 1445% and 76%, respectively, as the threshold value of 50%. Conclusion RDW is significantly increased in elderly patients with acute heart failure and differently expressed among HFpEF group, HFmrEF group and HFrEF group. When RDW<1405%, it is more likely to diagnose HFpEF. When 1405%≤RDW≤1445%, it is more likely to diagnose HFmrEF. When RDW>1445%, HFrEF is more likely to be diagnosed. RDW combined with NT-proBNP can be used as an effective index to quickly distinguish different ejection fraction types of acute heart failure in the elderlies.