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

Relationship between red cell distribution width and high-sensitivity C-reactive protein in acute coronary syndrome of elderly patients

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、hsCRP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 Creactive protein（ hs-CRP） and the severity of coronary artery disease in elderly patients with acute coronary syndrome（ ACS）. Methods A total of 178 elderly patients with ACS were enrolled. They were first hospitalized at the Xuanwu Hospital from January 2010 to April2014,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 100 points） in 69 cases,severe disease group（ ≥100 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. 312,P = 0. 008; F = 5. 249,P =0. 026）; 2 Using 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. 014,95% 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 forrisk stratification in elderly patients with ACS,which are simple,inexpensive,and practical.