慢性阻塞性肺病患者红细胞分布宽度与右心衰竭的相关性研究

Correlation between red blood cell distribution width and right heart failure in patients with chronic obstructive pulmonary disease

目的·探讨慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者红细胞分布宽度(red blood cell distribution width,RDW)与右心衰竭严重程度的关系。方法·收集2011年10月至2016年9月期间上海交通大学医学院附属瑞金医院呼吸与危重症医学科收治单纯COPD患者265例及COPD伴右心衰竭患者268例,后者参照美国纽约心脏协会(New York Heart Association,NYHA)心功能分级标准分为:A组(Ⅰ级),B组(Ⅱ级),C组(Ⅲ级)和D组(Ⅳ级)。获取所有患者入院后24 h内测定的RDW值、平均红细胞体积(mean corpuscular volume,MCV)、前脑钠肽、红细胞沉降率等指标。就不同组别患者RDW变化趋势和相关影响因素进行分析和比较。结果·在单纯COPD组和COPD伴右心衰竭组比较中,2组患者在性别、年龄、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、COPD急性加重次数比较中,差异均无统计学意义(均P>0.05)。在实验室指标比较中,2组患者红细胞计数、血红蛋白、MCV、RDW、前脑钠肽和动脉血氧分压均具有显著性差异(均P<0.05)。在COPD伴右心衰竭组内比较中,4组患者红细胞计数、血红蛋白、MCV、动脉血氧分压的差异均无统计学意义(均P>0.05)。但随着患者NYHA心功能分级的增加,前脑钠肽和RDW均呈相似的显著升高趋势(均P=0.000)。组间多重比较提示,4组两两之间比较差异均存在统计学意义(均P<0.05)。结论·COPD伴右心衰竭患者RDW显著升高,且与右心衰竭密切相关。

Objective·To investigate the relationship between the red blood cell distribution width(RDW)and the severity of right heart failure in patients with chronic obstructive pulmonary disease(COPD).Methods·A total of 265 patients with simple COPD and 268 COPD patients with right heart failure admitted to Department of Respiratory and Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from October 2011 to September 2016 were enrolled.According to the New York Heart Association(NYHA)criteria,all COPD patients with right heart failure were divided into Group A(ClassⅠ),Group B(ClassⅡ),Group C(ClassⅢ)and Group D(ClassⅣ).The RDW,mean corpuscular volume(MCV),pro-brain natriuretic peptide,and erythrocyte sedimentation rate were measured within 24 h after admission for all patients.The RDW trends and related influencing factors in different groups were analyzed and compared.Results·There was no significant difference in the gender,age,forced expiratory volume in one second(FEV1),and COPD exacerbation times between the COPD group and the COPD with right heart failure group(all P>0.05).However,there was a significant difference in red blood cell count(RBC),hemoglobin,MCV,RDW,pro-brain natriuretic peptide,and arterial partial pressure of oxygen(PaO2)(all P<0.05).In COPD with right heart failure group,there was no significant difference in age,RBC,hemoglobin,MCV,and PaO2 among the four groups(all P>0.05).With the increase of the patients′NYHA functional class,both pro-brain natriuretic peptide and RDW showed a similarly significant increase(both P=0.000).Through further multiple comparisons of RDW among four groups,there was a significant difference between any two groups(all P<0.05).Conclusion·RDW in patients with COPD with right heart failure is significantly elevated,and is closely related to right heart failure.