慢性心力衰竭患者红细胞分布宽度的临床研究

The clinical study of red blood cell distribution width in patients with chronic heart failure

目的通过对慢性心力衰竭患者红细胞分布宽度（RDW）与左室射血分数（LVEF）、左室舒张末内径（LVEDD）、高敏C反应蛋白（hs—CRP）、尿酸（uA）的相关性研究，探讨RDW水平与慢性心力衰竭患者心功能变化的关系及其可能的机制。方法选择280例患者作为研究对象，每位患者均接受心脏彩色多普勒超声、12导同步体表心电图、血生化及血常规检测。根据LVEF值、LVEDD值及RDW值不同进行分组，各组之间进行相关指标比较。结果根据患者LVEF值分组，从组A至组D，随着LVEF值逐渐减低，RDW值逐渐增加[（13．48±0．85）％、（14．10±1．46）％、（14．59±1．59）％、（14．75±1．42）％，F=12．698，P〈0．01]，各组间两两比较差异具有统计学意义（P〈0．01）；RDW水平与LVEF值呈负相关（r=-0．538，P〈0．01）。根据患者LVEDD值分组，从组a至组d，随着LVEDD值逐渐增大，RDW值逐渐增加[（13．53±0．91）％，（14．12±1．42）％，（14．60±1．68）％，（14．76±1．39）％，F=12．276，P〈0．01]；各组间两两比较差异具有统计学意义（P〈0．01）；慢性心力衰竭患者RDW水平与LVEDD值呈正相关（r=0．343，P〈0．01）。在慢性心力衰竭患者中，RDW与hs—CRP、尿酸值经对数转换（LguA）均呈正相关（r=0．486、0．513，P〈0．05）。结论RDW水平可反映慢性心力衰竭患者心功能的变化，随着LVEF值降低，LVEDD值增大，RDW值逐渐升高；RDW与hs—CRP、LgUA有较强的相关性，提示慢性心力衰竭患者RDW水平升高可能与炎性反应及氧化应激有关。

Objective To investigate the association between red blood cell distribution width （RDW） level and the change of cardiac function in patients with chronic heart failure （CHF） and explore its possible mechanism by studying the correlation between RDW and left ventricular ejection fraction （LVEF）, left ventricular end-diastolic dimension （LVEDD）, and high-sensitivity C-reactive protein （hsCRP） , and uric acid （UA） in patients with chronic heart failure. Methods Two hundred and eighty patients were included in our study. Each patient received the examinations of echocardiography, electrocar- diogram （ECG）, blood routine, and blood biochemistry. According to the different LVEF, LVEDD and RDW, the patients were divided into groups A, B, C, and D, respectively. The groups were compared with each other. Results According to the different LVEF , from group A to group D, with a progressive de- crease in LVEF, RDW level were increased gradually [ （ 13.48 ± 0. 85 ） %, （ 14. 10 ± 1.46） %, （ 14. 59 ± 1.59） %, （ 14. 75 ±1.42） % , F = 12. 698, P 〈 0. 01 ]. There was significant difference among the four groups （ P 〈 0. 01 ）. RDW level correlated inversely with LVEF（ r = -0. 538, P 〈 0.01 ）. According to the different LVEDD, from group A to group D, with a progressive increase in LVEDD, RDW level in- creased gradually [ （ 13.53 ±0. 91 ） %, （ 14. 12 ± 1.42） %, （ 14. 60 ± 1.68） %, （ 14. 76 ±1.39） %, F = 12. 276, P 〈 0. 01 ]. There was significant difference among the four groups （ P 〈 0. 01 ）. RDW level cor- related positively with LVEDD （ r =0. 343, P 〈0. 01 ）. In chronic heart failure patients, there were signif- icant linear correlation between RDW and hs-CRP, LgUA （ r = 0. 486, 0. 513, P 〈 0. 05 ）. Conclusions RDW correlated with the change of cardiac function in patients with chronic heart failure. With a progressive decrease in LVEF and a progressive increase in LVEDD, RDW level increased gradually. RDW had a strong correlation with hs-CRP, LgUA. This indicates that RDW level increase may be related to the inflam- mation and oxidative reaction in patients with chronic heart failure.