高血压患者的红细胞分布宽度与早期肾脏损害和心室重构的相关性

Relationship of red blood cell distribution width with early kidney injury and cardiac remodeling in patients with hypertension

目的研究高血压患者的红细胞分布宽度(RDW)与发生早期肾脏损害和心室重构的相关性。方法选择2016年8月~2017年8月于淮安第一医院行冠状动脉造影术或冠状动脉CT,血管管腔狭窄<50%的研究对象107例,按有无高血压分为高血压组76例和对照组31例。比较高血压组与对照组的RDW水平、肾小球滤过率(e GFR)的差异及其相关性;所有研究对象均行超声心动图检查,测量左室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、射血分数(EF)以及左室短轴缩短率(FS),进一步计算左心室质量指数(LVMI),分析RDW与超声心功能指标的相关性。行受试者工作特征(ROC)曲线分析,探讨RDW预测患者发生高血压靶器官损害的最佳界值。结果高血压组RDW水平高于对照组,差异有统计学意义(P<0.05),高血压组e GFR水平明显低于对照组,差异有统计学意义(P<0.05),高血压组LVEDD、IVST和LVMI显著高于对照组(P<0.05)。RDW水平与e GFR明显负相关(r=-0.236,P=0.140),与LVMI明显正相关(r=0.468,P<0.001)。ROC曲线分析显示,RDW预测早期肾脏损害的曲线下面积为0.623(P<0.05),RDW预测早期心室重构的曲线下面积为0.720(P<0.05)。多因素Logistic回归分析表明,RDW与高血压具有明显相关性(P<0.05)。结论高血压患者RDW水平与早期肾脏损害和心室重构的发生有显著的相关性,提示其可作为评估高血压患者早期靶器官损害的一项预测指标。

Objective To investigate the relationship of red blood cell distribution width （RDW） with early kidney injury and cardiac remodeling in patients with hypertension. Methods A total of 107 cases with coronary artery stenosis 〈50% diagnosed by coronary angiography or coronary CT angiography were selected in Huai＇an First People’s Hospital, Nanjing Medical University from Aug 2016 to Aug 2017. According to hypertension or not, 107 cases were divided into hypertension group（n=76） and control group（n=31）. The difference and correlation of RDW and estimated glomerular filtration rate（eGFR） were compared between the two groups. The left ventricular end-diastolic diameter （LVEDD）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, ejection fraction （EF） and fractional shortening （FS） of all the objects were measured by echocardiography, as well as the left ventricular mass index （LVMI）, and the correlation with RDW. Receiver operator characteristic （ROC） curve was used to find the optimal cutoff point for predicting the occurrence of early target organ damages of hypertension in these participants. Results The RDW levels in hypertension group were significantly higher than that in control group （P〈0.05）, while eGFR levels of hypertension group were significantly lower than control group （P〈0.05）. The LVEDD, IVST and LVMI levels were dramatically higher in hypertension group than in control groups （P〈0.05）. We found that RDW had a significantly correlation with eGFR （r=-0.236, P=0.140） and LVMI （r=0.468,P〈0.001）. ROC curve of RDW predicting early kidney injury and cardiac remodeling showed that the area under curve of RDW were 0.623 and 0.720（P〈0.05）, respectively. Multivariate logistic regression analysis showed that RDW was independently associated with hypertension （P〈0.05）. Conclusion RDW in patients with hypertension is correlated with early kidney injury and cardiac remodeling. Thus, RDW can be used as a predictor to evaluate the early target organ damages in hypertension patients.