红细胞分布宽度与特发性肺动脉高压病情和预后的相关性分析

摘要

目的:探讨红细胞分布宽度(RDW)与特发性肺动脉高压病情和预后的相关性.方法:连续入选经右心导管确诊为特发性肺动脉高压的患者76例.以RDW 13.5%作为界值将患者分为RDW≥13.5%组(n=43)与RDW< 13.5%组(n=33).对基线资料进行相关性分析及分组探讨,对随访结果绘制ROC曲线并作生存分析及COX回归.结果:相关分析结果显示,RDW与WHO肺动脉高压功能分级、右心室舒张末期前后径、N末端B型利钠肽原(NT-ProBNP)、大内皮素1呈正相关(r=0.40,P<0.001;r=0.29,P=0.013; r=0.36,P=0.002; r=0.31,P=0.012),与六分钟步行距离、左心室舒张末期前后径、心指数呈负相关(r=-0.3,P=0.029; r=-0.3,P= 0.01; r=-0.27,P=0.019).与NT-ProBNP﹑大内皮素-1相比,只有RDW预测患者两年内不良事件(死亡)发生的ROC曲线有统计学意义(P=0.003),曲线下面积0.766,以RDW 13.5%作为界值预测患者死亡的敏感度为0.9,特异度为0.7.Kaplan-Meier生存曲线:RDW<13.5%组预后明显好于RDW≥13.5%组,log-rank检验P< 0.001,差异有统计学意义.RDW≥13.5%组患者的肺动脉高压功能分级﹑NT-ProBNP和大内皮素-1水平较RDW<13.5%组偏高,差异有统计学意义(P<0.05).多因素COX回归显示,排除其他因素影响后,RDW≥13.5%仍是患者死亡的独立危险因素.结论:RDW与特发性肺动脉高压的病情和预后相关.高水平的RDW提示病情较重,预后较差,也是发生不良事件的独立危险因素.%Objective: To explore the relationship between circulating red cell distribution width (RDW) with the condition and prognosis in patients of idiopathic pulmonary arterial hypertension (IPAH).rnMethods: A total of 76 consecutive IPAH patients with confirmed diagnosis of right heart catheterization were enrolled in our work. Taking the cut-off value of RDW=13.5%, the patients were divided into 2 groups as RDW ≥ 13.5% group, n=43 and RDW<13.5% group, n=33. The baseline condition was recorded and compared between 2 groups and the follow-up outcome was studied with ROC curves and Cox regression survival analysis.rnResults: The correlation analysis indicated that RDW level positively related to WHO functional class (WHO-FC), (r = 0.40, P<0.001), right ventricular end diastolic diameter (r=0.29, P=0.013), NT-ProBNP (r=0.36, P=0.002), endothelin-1 (r=0.31, P= 0.012); and negatively related to 6 minutes walking distance (r=-0.3, P=0.029), left ventricular end diastolic diameter (r=-0.3, P=0.01), and cardiac index (r =-0.27, P=0.019). ROC curve presented that compared with NT-ProBNP and endothelin-1, RDW was the effective predictor for 2 year all-cause mortality in IPAH patients, P=0.003, the area under the curve was 0.766. Based on cut-off value of 13.5%, the sensitivity for RDW prediction in IPAH mortality was 88.9%, in specificity was 66.7%. Survival analysis showed that RDW<13.5% group had better prognosis than RDW ≥ 13.5% group, P<0.001. RDW ≥ 13.5% group had higher levels of WHO-FC, NT-ProBNP and endothelin-1 than that in RDW<13.5% group, P<0.05. Multi-Cox regression analysis suggested that RDW ≥ 13.5% is an independent risk factor for death in IPAH patients.Conclusion: RDW level related to clinical condition and prognosis in IPAH patients. Higher level of RDW indicated worse condition with poor prognosis, it was an independent risk factor for adverse events.