CAJ | 학술논문

目的探讨红细胞分布宽度(RDW)对慢性收缩性心力衰竭(心衰)患者预后的预测价值及相关因素分析.方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000年至2010年心衰住院患者临床资料,所有患者经电话随访.根据RDW将患者分为≤l3.2％(3981例)、13.3％～ 14.1％(3996例)、14.2％～ 14.8％(4319例)和≥14.9％(4385例)组,根据平均红细胞体积(MCV)将RDW＞ 16％患者分为MCV减低组(MCV＜ 82 fl,420例)、MCV升高组(MCV ＞92 fl,646例)和MCV正常组(MCV≥82 fl、≤92 fl,632例).根据患者是否死亡,分为死亡组和存活组.以单因素和多因素Cox生存分析评价RDW预测总体和不同病因心衰患者预后价值、不同RDW组和MCV组总死亡风险.单因素和多因素回归分析评价RDW与其他指标相关性.结果 (1)共16 681例患者纳入研究.以RDW≤13.2％组做参照,RDW13.3％～14.1％、14.2％～ 14.8％和≥14.9％组总死亡风险分别为0.892(95％ CI0.818 ～0.973,P=0.01)、0.859(95％ CI 0.793 ～0.931,P＜0.01)和1.034(95％ CI 0.961 ～1.111,P=0.373).(2)在RDW ＞16％患者中,以风湿性瓣膜病做参考,缺血性心肌病、扩张型心肌病和高血压心脏病总死亡风险分别为1.437(95％ CI 1.141～1.810,P＜0.01)、1.651(95％ CI 1.276 ～2.138,P＜0.01)和1.276(95％CI 1.004～1.621,P＜0.01). (3)在RDW＞ 16％患者中,以MCV正常组做参照,MCV升高组和MCV减低组总死亡风险分别为1.351(95％CI 1.063 ～1.718,P＜0.01)和1.316(95％ CI 1.034 ～1.675,P＜0.01).(4) RDW相关因素在不同病因中存在差异.结论慢性收缩性心衰患者总病死率与RDW间存在J型分布,RDW升高伴MCV增高或减低均增加总死亡风险,评价RDW的预后价值需考虑病因因素.
목적 탐토홍세포분포관도(RDW)대만성수축성심력쇠갈(심쇠)환자예후적예측개치급상관인소분석.방법 회고성조사화분석호북지구8지시12가삼급갑등의원2000년지2010년심쇠주원환자림상자료,소유환자경전화수방.근거RDW장환자분위≤l3.2％(3981례)、13.3％～ 14.1％(3996례)、14.2％～ 14.8％(4319례)화≥14.9％(4385례)조,근거평균홍세포체적(MCV)장RDW＞ 16％환자분위MCV감저조(MCV＜ 82 fl,420례)、MCV승고조(MCV ＞92 fl,646례)화MCV정상조(MCV≥82 fl、≤92 fl,632례).근거환자시부사망,분위사망조화존활조.이단인소화다인소Cox생존분석평개RDW예측총체화불동병인심쇠환자예후개치、불동RDW조화MCV조총사망풍험.단인소화다인소회귀분석평개RDW여기타지표상관성.결과 (1)공16 681례환자납입연구.이RDW≤13.2％조주삼조,RDW13.3％～14.1％、14.2％～ 14.8％화≥14.9％조총사망풍험분별위0.892(95％ CI0.818 ～0.973,P=0.01)、0.859(95％ CI 0.793 ～0.931,P＜0.01)화1.034(95％ CI 0.961 ～1.111,P=0.373).(2)재RDW ＞16％환자중,이풍습성판막병주삼고,결혈성심기병、확장형심기병화고혈압심장병총사망풍험분별위1.437(95％ CI 1.141～1.810,P＜0.01)、1.651(95％ CI 1.276 ～2.138,P＜0.01)화1.276(95％CI 1.004～1.621,P＜0.01). (3)재RDW＞ 16％환자중,이MCV정상조주삼조,MCV승고조화MCV감저조총사망풍험분별위1.351(95％CI 1.063 ～1.718,P＜0.01)화1.316(95％ CI 1.034 ～1.675,P＜0.01).(4) RDW상관인소재불동병인중존재차이.결론 만성수축성심쇠환자총병사솔여RDW간존재J형분포,RDW승고반MCV증고혹감저균증가총사망풍험,평개RDW적예후개치수고필병인인소.
Objective To determinate the prognostic value of red cell distribution width (RDW) and the relationships between RDW and clinical characteristics in patients with chronic heart failure (CHF).Methods A total of 16 681 in-hospital patients with chronic systolic HF and LVEF ＜50％ from 12 hospitals in Hubei province,China were enrolled.All patients were followed up with telephone call.Patients were divided into RDW ≤ 13.2％ (n =3981 ),13.3％ - 14.1％ (n =3996),14.2％ - 14.8％ ( n =4319) and ≥14.9％ (n =4385 )groups.Multivariate Cox regression analysis was performed to determine whether RDW is an independent risk factor of all-cause mortality in overall patients,patients with various etiologies.Multivariate Cox proportional hazard analysis was performed to determine the risk of all-cause mortality among various RDW groups.Results ( 1 ) Compared with RDW ≤ 13.2％ group,adjusted hazard ratios (HRs) and 95％ confidence intervals (CIs) of all-cause mortality for RDW 13.3％ -14.1％,14.2％ -14.8％ and ≥ 14.9％ were 0.892 (95 ％ CI 0.818-0.973,P =0.01 ),0.859 (95 ％ CI 0.793 -0.931,P ＜0.01) and 1.034 (95％ CI 0.961 - 1.111,P =0.373) respectively. (2) Compared with MCV normal group,the adjusted HRs of MCV elevation and MCV decline groups were 1.351 (95％ CI 1.063 - 1.718,P ＜0.01 ) and 1.316 (95％ CI 1.034 - 1.675,P ＜ 0.01 ),respectively.(3) Compared to patients with rheumatic heart diseases,the adjusted HR for all-cause mortality in patients with coronary heart disease,dilated cardiomyopathy and hypertensive heart disease with RDW ＞ 16％ were 1.437 (95％ CI 1.141 -1.810,P＜0.01),1.651 (95％ CI 1.276 -2.138,P＜0.01) and 1.276 (95％ CI 1.004- 1.621,P ＜ 0.01 ),respectively.(4) The RDW is independently correlated with BMI ( r =- 0.345,P ＜ 0.01 ),diastolic blood pressure( r =- 0.321,P ＜ 0.01 ),albumin ( r =- 0.411,P ＜ 0.01 ),blood urine nitrogen ( r =0.476,P ＜ 0.01 ),right ventricular end-diastolic diameter( r =0.383,P ＜ 0.01 ),LVEF ( r =- 0.463,P ＜0.01 ) and heart rate( r =0.379,P ＜0.01 ).Conclusions There is a J shape relationship between allcause mortality and RDW.The elevation or decline of MCV with increased RDW is hnked with increased allcause mortality in CHF patients.