红细胞分布宽度与老年患者慢性心力衰竭严重程度及脑钠肽的相关性

摘要

目的：研究老年慢性心力衰竭( CHF)患者红细胞分布宽度( RDW)与心功能的关系,探讨其作为心力衰竭指标的临床评估价值。方法回顾性分析2008年6月—2011年12月住院的368例老年心力衰竭患者。自动化全血细胞分析仪测患者RDW,酶联免疫吸附分析( ELISA)法测定血浆脑钠肽( BNP)浓度,超声心动图Simpson法测定左心室射血分数( LVEF)。采用直线相关分析法分析各指标间的相关性。结果根据NYHA心功能分级将心力衰竭患者分成3组,其中II级组82例、III级组187例,IV级组99例,各组RDW和BNP浓度显著不同,并随心功能级数增高而显著升高,即IV级组>III级组>II级组( F =10.012, F =13.582, P <0.01)；根据LVEF=45%为切点将心力衰竭患者分为LVEF降低组和LVEF保留组,前者RDW及BNP显著高于后者(RDW：16.4%±1.6% vs.14.2%±1.5%, P <0.01；BNP：643 ng/L ±168 ng/L vs.232 ng/L ±113 ng/L)；根据BNP水平将心力衰竭患者分成低、中、高3组,高BNP组RDW(16.2±1.4)%显著高于中BNP组(15.2± 0.9)%、低BNP组(13.7±1.1)%( q值分别为18.2和45.82, P <0.01)；相关性分析显示RDW与BNP显著呈正相关( r =0.3238, P <0.01),与LVEF呈负相关( r =-0.218, P <0.01)。结论 RDW在NYHA心功能分级高、LVEF降低及高BNP老年心力衰竭患者中显著升高,并与BNP浓度呈正相关,与LVEF呈负相关,提示RDW可作为评估老年心力衰竭严重程度的方便有用辅助指标。%Objective To investigate the relationship between red blood cell distribution width ( RDW) and the car-diac function in old patients with chronic heart failure( CHF) and to evaluate the prognostic value of RDW in CHF. Methods From 2008 June to 2011 December, retrospective analysis 368 cases of hospitalized elderly patients with CHF. Automatic blood cell analyzer measured patients' RDW,ELISA was used for the determination of plasma brain natriuretic protein( BNP) concentration, determination of left ventricular ejection fraction(LVEF) by echocardiography Simpson method. Correlation be-tween different indexes was analyzed by using linear correlation analysis method. Results According to NYHA classification, patients were divided into three groups, Class II heart failure group of 82 cases, 187 cases in class III group, class IV group of 99 cases, in each group, RDW and BNP concentration was significantly different, and significantly increased with the pro-gression in the order of class IV group> class III group> class II group ( F =10. 012,13. 582, P <0. 01); according to LVEF=45% as the cut-off point,patients were divided into LVEF decrease groups and LVEF retention group,former group's RDW and BNP were significantly higher than the latter group (RDW:16. 4% ± 1. 6% vs. 14. 2% ± 1. 5%, P <0. 01;BNP:643 ng/L ± 168 ng/L vs. 232 ng/L ± 113 ng/L);according to BNP levels, heart failure patients were divided into low, medi-um, and high BNP group, high BNP group's RDW (16. 2 ± 1. 4)% was significantly higher than that of medium (15. 2 ± 0. 9) %, and low level group (13. 7 ± 1. 1)% ( q =18. 2,45. 82, P <0. 01);correlation analysis showed RDW significant-ly positive correlated with BNP ( r =0. 323 8, P <0. 01), and negatively related with LVEF ( r = -0. 218, P <0. 01). Conclusion RDW was significantly increased in NYHA advanced class of the heart function, LVEF decreased and high BNP elderly patients, and was positively correlated with BNP and negatively correlated with LVEF, suggesting that RDW can be used as a convenient and useful auxiliary index assessment of the severity of heart failure in the elderly.