红细胞分布宽度、肾小球滤过率与慢性心力衰竭的相关性研究

Correlation study of red blood cell volume distribution width, glomerular filtration rate and chronic heart failure

目的研究红细胞分布宽度(RDW)、肾小球滤过率(GFR)与慢性心力衰竭的相关性,并探讨其可能的机制和意义。方法收集160例慢性心力衰竭患者的住院病历资料,根据纽约心脏病学会(NYHA)心功能分级分为:心功能Ⅱ级组(n=52),心功能Ⅲ级组(n=58),心功能Ⅳ级组(n=50)。另选取40例同期住院的非慢性心力衰竭患者作为对照组,比较RDW、GFR、血红蛋白(Hb)、脑钠肽(BNP)、心脏超声相关参数、左心室质量(LVM)和左心室质量指数(LVMI)等在各组间的变化差异,分析RDW、GFR与慢性心力衰竭严重程度的相关性。结果随着NYHA心功能分级的逐步增加,RDW水平呈逐渐升高趋势,GFR、Hb水平呈逐渐降低趋势,且各组间差异均有统计学意义:RDW(12.31±0.34)%vs(14.24±0.74)%、(15.11±0.74)%、(16.18±0.89)%,GFR(106.70±22.01)ml.min-1.1.73m-2 vs(83.32±15.38)ml.min-1.1.73m-2、(69.63±13.20)ml.min-1.1.73m-2、(61.48±13.46)ml.min-1.1.73m-2,Hb(145.15±9.09)g/L vs(137.65±11.13)g/L、(129.14±13.58)g/L、(117.84±14.86)g/L(均P<0.01)。经相关性分析,RDW和BNP、LVEDd、LVM、LVMI呈正相关(r=0.652、0.639、0.420、0.432,均P<0.01),和LVEF呈负相关(r=-0.733,P<0.01);GFR和BNP、LVEDd、LVM、LVMI呈负相关(r=-0.481、-0.377、-0.199、-0.333,P<0.05或<0.01),和LVEF呈正相关(r=0.456,P<0.01);RDW和Hb、GFR呈负相关(r=-0.815、-0.532,P<0.01),Hb和GFR呈正相关(r=0.659,P<0.01)。结论 RDW、GFR水平和慢性心力衰竭严重程度之间存在显著的相关性:慢性心力衰竭患者的心功能越差,左心室重构程度越重,则RDW水平越高,GFR水平越低。RDW和GFR可作为评估慢性心力衰竭严重程度的有力指标。

Objective To study the correlation of red blood cell volume distribution width（RDW）,glomerular filtration rate（GFR） and chronic heart failure（CHF）,and discuss the possible mechanism and significance. Methods Medical records of 160 inpatients with CHF were collected and divided into three groups based on NYHA heart function classification： heart function class Ⅱ group （ n = 52）, heart function class Ⅲ group （ n= 58）, heart function class Ⅳ group（ n =50）. 40 inpatients without CHF were selected during the same period as control group. RDW,GFR, H b,brain natriuretic peptide （BNP）, echocardiography parameters, left ventricular mass （LVM） and left ventricular mass index（LVMI） were compared among different groups,and the correlation of RDW,GFR and the severity of CHF were analyzed. Results With the gradual increase of NYHA heart function classification, the level of RDW showed gradual increase tendency, and the levels of GFR and Hb showed gradual decrease tendency. The differences among different groups had statistical signifieances：RDW（12.31 ±0.34） % vs （14.24±0.74）%, （15.11±0.74）%, （16. 18± 0.89）% ,GFR（106.70±22.01） ml·min^-1·1.73m^-2 vs （83.32±15.38） ml·min^-1·1.73m^-2 ,（69.63±13.20） ml·min^-1·1.73m^-2,（61.48±13.46） ml·min^-1·1.73m^-2,Hb（145.15±9.09） g/L vs （137.65±11.13） g/L, （129.14±13.58） g/L, （117.84±14.86） g/L（all P〈0.01）. Correlation analysis showed RDW had positive correlation with BNP, LVEDd, LVM and LVMI （ r = 0. 652,0. 639,0. 420,0. 432, all P % 0.01 ）, RDW had negative correlation with LVEF（ r =-0. 733, P 〈0.01）; GFR had negative correlation with BNP, LVEDd, LVM and LVMI （r = -0. 481,-0. 377,-0. 199,-0. 333, P 〈0.05 or 〈0.01）,GFR had positive correlation with LVEF（ r =0. 456, P 〈0.01）; RDW had negative correlation with Hb and GFR（r =-0.815,-0.532, P 〈0.01）, Hb had positive correlation with GFR （ r =0. 659, P〈0.01）. Conclusion The levels of RDW and GFR had remarkable correlation with the severity of CHF： in patients with CHF,the worse the heart function was,the more severe the left ventricular remodeling was, the patients would have higher level of RDW and lower level of GFR. RDW and GFR could be used as two strong indexes to evaluate the severity of CHF.