老年急性冠状动脉综合征患者红细胞分布宽度与超敏C反应蛋白的关系

摘要

目的：探讨老年急性冠状动脉综合征（acute coronary syndrome，ACS）患者红细胞分布宽度（red blood cell distribution width，RDW）、超敏C反应蛋白（high sensitivity C-reactive protein，hs-CRP）与冠状动脉病变严重程度的关系，进而分析RDW与炎性标志物超敏C反应蛋白（hs-CRP）的关系，探讨RDW增高的机制。方法选取2010年1月至2014年4月在首都医科大学宣武医院心脏科首次住院的老年ACS患者178例，根据冠状动脉造影结果将冠状动脉病变进行改良Gensini积分，根据Gensini积分进一步分为轻度病变组（＜50分）48例、中度病变组（50～100分）69例、重度病变组（≥100分）61例，冠状动脉正常组38例为对照组。所有研究对象均进行了入院后首次RDW、hs-CRP及肝肾功能、血糖、血脂检测。结果①老年ACS患者的RDW、hs-CRP较对照组明显升高，差异具有统计学意义（F＝7.312，P＝0.008；F＝5.249，P＝0.026）；②以改良Gensini积分为因变量，多因素Logistic回归分析显示，RDW、hs-CRP是冠状动脉病变严重程度的独立预测因素（OR＝2.014，95％CI：1.736～3.794；OR＝1.896，95％CI：1.492～3.989）；③老年ACS患者RDW与hs-CRP水平呈正相关（r＝0.21，P＜0.05）。结论①老年ACS患者的RDW、hs-CRP升高，RDW与hs-CRP可作为冠状动脉病变严重程度的独立预测因素。②老年ACS患者RDW值的升高与炎性标志物（hs-CRP）呈正相关，表明RDW升高的机制可能与机体的慢性炎性反应有关。RDW、hs-CRP可作为临床上评价老年ACS患者冠状动脉病变严重程度、进行早期危险分层的简单、廉价、实用的方法。%Objective To investigate the relationship between the red blood cell distribution width (RDW),high sensitivity C-reactive protein (hs-CRP)and the severity of coronary artery disease in elderly patients with acute coronary syndrome (ACS).Methods A total of 1 78 elderly patients with ACS were enrolled.They were first hospitalized at the Xuanwu Hospital from January 201 0 to April 201 4,their coronary culprit lesion was improved by Gensini score,according to the results of coronary angiography.Based on the Gensini score,the patients were further divided into mild lesion group (<50 points)in 48 cases,moderate lesion group (50 to 1 00 points)in 69 cases,severe disease group (≥1 00 points)in 61 cases;There were 38 cases without coronary disease were enrolled as normal control group.All patients were tested for their RDW and hs-CRP after admission.Results ①RDW and hs-CRP were significantly higher in the elderly patients with ACS than in the control group,the difference is statistically significant (F=7.31 2,P=0.008;F=5.249,P=0.026);②Using Gensini score as dependent variable,Logistic regression analysis showed that RDW and hs-CRP were independent predictors for the severity of coronary artery lesion(OR=2.01 4,95%CI:1.736~3.794;OR=1.896,95%CI:1.492~3.989);③RDW and hs-CRP levels were positively correlated (r =0.21 ,P<0.05 )in elderly patients with ACS.Conclusion ①RDW and hs-CRP seem to be independent predictors for the severity of coronary artery lesion.②The mechanism of elevated RDW may be related to chronic inflammation.RDW and hs-CRP can be used as markers for clinical evaluation of severity of coronary artery disease and may be used for risk stratification in elderly patients with ACS,which are simple,inexpensive,and practical.