红细胞体积分布宽度和超敏C反应蛋白与冠心病的相关性研究

Study on correlation between red blood cell distribution width and high sensitive C-reactive protein with coronary heart disease

目的探讨红细胞体积分布宽度（RDW）和超敏C反应蛋白（hs-CRP）与冠心病的相关性。方法选取冠心病患者146例为冠心病组,选择同期健康体检者70例为对照组。根据疾病类型,将冠心病组分为稳定性心绞痛（SAP）组66例,不稳定性心绞痛（UAP）组53例,急性心肌梗死（AMI）组27例。根据病变支数分组,将冠心病组分为单支病变组65例,双支病变组48例,多支病变组33例。对所有研究对象分别检测RDW、红细胞平均体积（MCV）、血细胞比容（Hct）、血小板计数（PLT）和平均血小板体积（MPV）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、总胆固醇（TC）、三酰甘油（TG）、肌酐（Cr）、尿素氮（BUN）、尿酸（UA）、葡萄糖（GLU）、总胆红素（TBIL）及hs-CRP水平。应用ROC曲线评价RDW和hs-CRP对冠心病的诊断价值,应用多元Logistic回归分析预测冠心病的独立危险因素。结果与对照组比较,冠心病组LDL、hs-CRP及RDW水平明显升高（P〈0.05）。AMI组血清hs-CRP和RDW水平明显高于SAP组（P〈0.01）,且AMI组血清hs-CRP水平明显高于UAP组（P〈0.05）。多支病变组血清hs-CRP和RDW水平明显高于单支病变组和双支病变组（P〈0.01）,且双支病变组RDW水平明显高于单支病变组（P〈0.05）。RDW和hs-CRP的ROC曲线下面积（AUC）分别为0.769（95%CI：0.683-0.842）、0.732（95%CI：0.656-0.820）。RDW和hs-CRP的最佳临界值分别为14.65%和5.92mg/L,这时的灵敏度和特异度分别为75.8%、61.7%和74.5%、62.1%。多元Logistic回归分析显示,RDW、HDL、吸烟史和性别进入回归模型,回归系数分别为0.624、-7.254、0.630、0.947。结论 RDW和hs-CRP与冠状动脉病变和冠心病病情的严重程度有关,高水平的RDW可能是冠心病的独立影响因素。

Objective To investigate the correlation between the red blood cell distribution width（RDW）and high sensitive C reactive protein（hs-CRP）with coronary heart disease（CHD）.Methods 146 cases of CHD were selected as the CHD group and divided into the stable angina pectoris（SAP）group（66cases）,unstable angina pectoris（UAP）group（53cases）and acute myocardial infarction（AMI）group（27cases）.Contemporaneous 70 cases of healthy physical examination were selected as the control group.RDW,Hb,RBC count,WBC count,MCV,Hct,PLT,MPV,HDL,LDL,TC,TG,Cr,BUN,UA,GLU,TBIL and hs-CRP levels were detected in each group.The ROC curve was adopted to evaluate the diagnostic value of RDW and hs-CRP to CHD and the multivariate Logistic regression analysis was applied to predict the independent risk factors of CHD.Results Compared with the control group,LDL,hs-CRP and RDW levels in the CHD group were increased significantly,the differences were statistically significant（P〈0.05）.Serum hs-CRP and RDW levels in the AMI group were significantly higher than those in the SAP group（P〈0.01）,moreover serum hs-CRP level was significantly higher than that in the UAP group（P〈0.05）.The serum hs-CRP and RDW levels in the multi vessels lesion group were significantly higher than those in the single vessel lesion group and double vessels lesion group（P〈0.01）,moreover the RDW level in the double vessels lesion group was significantly higher than that in the single vessel disease group（P〈0.05）.The area under curve（AUC）of ROC curves of RDW and hs-CRP were that and 95%confidence interval of RDW and hs-CRP were 0.769（95%CI：0.683-0.842）,0.732（95%CI：0.656-0.820）.The optimal critical value of RDW and hs-CRP were14.65% and 5.92mg/L,the sensitivity and the the specificity were0.769（95%CI：0.683-0.842）and 0.732（95%CI：0.656-0.820）respectively.The optimal critical values of RDW and hs-CRP were hs-CRP,their sensitivity and specificity were 75.8%,61.7% and 74.5%,62.1% respectively.The multivariate Logistic regression analysis showed that RDW,HDL,smoking history and gender entered to the regression model,the regression coefficients were 0.624,7.254,0.630 and 0.947 respectively.Conclusion RDW and hs-CRP are associated with the severity of coronary artery lesions and CHD,high level of RDW may be an independent risk factor of CHD.