标题：红细胞分布宽度与陈旧性心肌梗死并维持性血液透析患者心力衰竭程度及短期不良预后的关系

      作者：杜发旺 1，冉燕 2*，李玲 1，陈丹丹 1，吴玥婷 1，陈保林 1    (贵州省人民医院心内科 1、肾内科 2，贵州 贵阳 550000)

      卷次： 2018年29卷20期

      【摘要】 目的 探讨红细胞分布宽度(RDW)与陈旧性心肌梗死并维持性血透析患者心力衰竭程度是否相关及其对患者短期不良预后的预测价值。方法 共纳入2012-2016年于贵州省人民医院心内科因心力衰竭住院且既往明确诊断为心肌梗死并于本院肾内科长期行维持性血液透析的患者共计107例，记录患者的基线临床资料，随访6个月，按患者预后分为生存组及死亡组；按NYHA心功能分级分为Ⅱ~Ⅳ级；按心力衰竭类型分为射血分数降低的心力衰竭(HFrEF，EF<40%)、射血分数保留的心力衰竭(HFpEF，EF≥50%)和射血分数临界的心力衰竭(HFmrEF，EF 40%~49%)。分析RDW与患者心力衰竭程度相关性及其对患者短期不良预后的预测价值。结果 (1) NYHAⅡ级、Ⅲ级和Ⅳ级患者的RDW分别为(37.1±1.1) fL、(39.5±2.6) fL和(46.3±5.3) fL，三组间RDW水平比较差异有显著统计学意义(F=45.13，P<0.01)，两两比较差异均有统计学意义(P<0.05)；NYHAⅡ级、Ⅲ级和Ⅳ级患者的N末端脑钠肽前体 (NT-BNP)水平分别为 (900.1±383.3) pg/mL、(3 570.9±2974.4) pg/mL和 (7 788.3±4 583.6) pg/mL，三组间NT-BNP水平比较差异有显著统计学意义(F=28.77，P<0.01)，两两比较差异也均有统计学意义(P<0.05)；多元线性回归分析显示RDW与NT-BNP存在线性正相关(R2=0.339)。(2) HFrEF组、HFpEF组和HFmrEF组患者中，RDW分别为(43.1±5.6) dL、(38.2±0.7) dL及(41.6±5.8) fL，与HFpEF组比较，HFrEF组及HFmrEF组患者的RDW水平明显升高，差异具有统计学意义(P<0.05)，HFrEF组较HFmrEF组RDW也有所升高，但差异无统计学意义(P>0.05)。(3) RDW预测患者短期不良预后的ROC曲线下面积为 0.95，其预测价值高于NT-BNP。最佳截点值为 46.5 fL。结论 RDW可反映陈旧性心肌梗死并维持性血液透析的心力衰竭程度，其水平与心衰程度呈正相关；RDW可用于预测该类患者短期不良预后，其价值优于NT-BNP；HFrEF及HFmrEF组患者的RDW水平明显升高。
      【关键词】 红细胞分布宽度；陈旧性心肌梗死；维持性血液透析；心力衰竭；短期不良预后
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2823—04

Association of red cell distribution width with severity of heart failure and its predictive value for short-termpoor prognosis in patients with old myocardial infarction undergoing maintenance hemodialysis.
DU Fa-wang 1,RAN Yan 2, LI-Ling 1, CHEN Dan-dan 1, WU Yue-ting 1, CHEN Bao-lin 1. Department of Cardiology 1, Department ofNephrology 2, Guizhou Provincial People's Hospital, Guizhou 550000, Guiyang, CHINA
【Abstract】 Objective To study the association of red cell distribution width (RDW) with severity of heart fail-ure and the predictive value of RDW for short-term poor prognosis in patients with old myocardial infarction undergoingmaintenance hemodialysis. Methods A total of 107 hospitalized patients due to heart failure who were diagnosed asmyocardial infarction in Department of Cardiology, Guizhou Provincial People's Hospital and underwent maintenancehemodialysis in Department of Nephrology, Guizhou Provincial People's Hospital from 2012 to 2016 were recruited.Baseline clinical data of patients were recorded. The patients were followed up for 6 months, which were divided intosurvival group and death group according to the prognosis of the patients. According to the NYHA heart function classifi-cation, the patients was divided intoⅡ-Ⅳ level. According to the type of heart failure, they were divided into heart fail-ure with reduced ejection fraction (HFrEF, EF<40%), heart failure with preserved ejection fraction (HFpEF, EF≥50%)and heart failure with critical ejection fraction (HFmrEF, EF 40%-49%). Correlation between RDW and the degree ofheart failure and its value in predicting the short-term adverse prognosis of patients were analyzed. Results (1) The lev-els of RDW in patients with NYHAⅡ, NYHAⅢ, NYHAⅣ were (37.1±1.1) fL, (39.5±2.6) fL, (46.3±5.3) fL, respec-tively. The difference in RDW level among the three groups were statistically significant (F=45.13, P<0.01), and the dif-ference between each two groups were also statistically significant (P<0.05). The levels of NT-BNP in patients withNYHAⅡ, NYHAⅢ, NYHAⅣ were (900.1±383.3) pg/mL, (3 570.9±2 974.4) pg/mL, (7 788.3±4 583.6) pg/mL, re-spectively. The difference in NT-BNP level among the three groups were statistically significant (F=28.77，P<0.01), andthe differences between each two groups were also statistically significant (P<0.05). The liner regression analysis·论 著·doi:10.3969/j.issn.1003-6350.2018.20.004基金项目：国家临床重点专科建设项目(编号：国卫办医函[2013]554号)；贵州省科学技术厅临床研究中心项目(编号：黔科合平台人才[2017]5405)