老年收缩性与舒张性心力衰竭患者红细胞分布宽度的对比研究

Red cell distribution width in elderly patients with systolic and diastolic heart failure

目的探讨老年收缩性心力衰竭（SHF）与舒张性心力衰竭（DHF）患者红细胞分布宽度（RDW）水平及意义。方法选择2013年3月~2014年11月于首都医科大学宣武医院心脏科就诊的老年心力衰竭患者90例,根据LVEF不同分为SHF（LVEF〈50%）组55例和DHF（LVEF≥50%）组35例。另选同期年龄、性别相匹配的65例无心力衰竭患者为对照组。收集患者的临床资料,分析RDW在SHF与DHF患者的相关性及诊断意义。结果SHF组RDW、尿酸、左心房内径、左心室舒张末期内径显著大于DHF组[（13.9±1.0）%vs（13.0±0.5）%、（417.6±151.0）μmol/L vs（339.9±89.7）μmol/L、（41.8±7.1）mmvs（33.9±7.2）mm、（58.5±12.5）mmvs（48.6±8.8）mm,P〈0.05],而室间隔厚度显著小于DHF组（P〈0.05）。Pearson相关分析显示,LVEF与RDW、尿酸、B型钠尿肽、左心房内径呈负相关（P〈0.01）。RDW鉴别诊断SHF与DHF的曲线下面积为0.757,RDW取值13.35%作为界值的敏感性为67.3%,特异性为74.3%。结论在老年心力衰竭患者中,SHF比DHF的RDW水平更高,RDW对鉴别诊断SHF和DHF可能有一定帮助,当RDW〉13.35%时,诊断SHF的可能性大。

Objective To study the red blood cell distribution width（RDW） in elderly patients with systolic hear failure （SHF） and diastolic hear failure （DHF）. Methods Ninety elderly HF pa- tients were divided into SHF group with their LVEF〈50% （n=55） and DHF group with their LVEF〈50% （n=35）. Another 65 age- and gender-matched non-HF patients served as a control group. Correlation of RDW in SHF and DHF patients and the role of RDW in diagnosis of HF were analyzed. Results The RDW was significantly wider, the serum UA and BNP levels were significantly higher,the LAD and LVEDD were significantly larger while the ventricular septum thickness was significantly thinner in SHF group than in DHF group （P〈0.05）. Pearson correla- tion analysis showed that the LVEF was negatively related with the RDW, serum UA and BNP levels,and the LA diameter （P〈0.01）. The area under ROC of RDW was0. 757 for the differen- tential diagnosis of SHF and DHF. The sensitivity and specificity of RDW were 67. 3% and 74.3% for the diagnosis of SHF and DHF when its shreshold value was 13.35%. Conclusion The RDW is wider in elderly SHF patients than in elderly DHF patients. RDW plays a certain role in differential diagnosis of SHF and DHF. SHF can be diagnosed when RDW is wider than 13.35 %.