红细胞分布宽度对行急诊PCI治疗的ST段抬高型心肌梗死患者预后的影响

摘要

Objective To investigate the value of red distribution width (RDW) in predicting the prognosis of STEMI patients undergoing primary PCI.Methods A total of 520 patients with diagnosis of STEMI who underwent emergency primary PCI from December 2013 to February 2016 in the department of cardiology,Navy General Hospital were included in this retrospective study.According to the preoperative RDW,STEMI patients were divided into low RDW group (RDW ≤ 13％,n=389) and high RDW group (RDW ＞ 13％,n=131) with a median split (median 13％).The predictive value of preoperative RDW level and the incidence of MACE events were compared between two groups during hospitalization and one-year after PCI,and the prognostic factors of STEMI patients after PCI operation were investigated by univariate and multivariate Logistic regression analysis.Results Compared with the low level of RDW group,the incidences of MACE events in the high RDW group after PCI during the postoperative hospitalization (4.7％ vs 15.3％,P ＜ 0.001),and 1 year after PCI (9.3％ vs 29％,P ＜ 0.001) were higher.Univariate Logistic regression analysis found that age (OR=1.019,95％CI:1.001-1.039,P=0.044),Hb (OR=0.985,95％CI:0.972-0.998,P=0.024),RDW (OR=2.212,95％CI:1.602-3.045,P ＜ 0.001) were related with the occurrence of MACE events.Multivariate Logistic regression analysis showed that only RDW (OR=1.831,95％CI:1.372-2.445,P ＜ 0.001) was independent risk factor.Conclusion Reoperative RDW level can predict the prognosis of patients with STEMI undergoing emergency PCI,and patients with high RDW level is more likely to develop of MACE.%目的 探讨术前红细胞分布宽度(red blood cell distribution width,RDW)水平对急诊行经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)治疗的ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者预后的影响.方法 纳入2013年12月-2016年2月在海军总医院心血管内科住院并接受急诊PCI治疗的急性STEMI患者520例.根据患者术前红细胞分布宽度水平,用中位数法(中位数为13％)将STEMI患者分为低RDW水平组(RDW≤13％)和高RDW水平组(RDW＞13％),两组研究样本量分别为389例和131例.比较术前RDW水平对STEMI患者在住院期间与术后1年主要心血管不良事件(major adverse cardiac events,MACE)发生率的影响,并通过单因素、多因素Logistic回归分析研究STEMI患者预后的影响因素.结果 与低RDW水平组比较,高RDW水平组STEMI患者PCI术后住院期间(4.7％ys 15.3％,P＜0.001)、术后1年(9.3％ vs 29％,P＜0.001) MACE发生率更高.经单因素分析,影响患者MACE发生率因素有年龄、血红蛋白及RDW.其中术前RDW水平在多因素分析中为独立影响因素(P＜0.001).结论 术前高RDW水平的STEMI患者发生MACE的概率高,术前RDW水平对接受急诊冠脉介入治疗的STEMI患者的预后有预测作用.