红细胞分布宽度与非透析慢性肾脏疾病患者心肌肥厚的关系

Relationship between Red Blood Cell Distribution Width and Myocardial Hypertrophy in Patients with Non-dialysis Chronic Kidney Disease

目的研究慢性肾脏病(CKD)患者红细胞分布宽度(RDW)以及左心室肥厚(LVH)及左室心肌质量指数(LVMI)之间的相关性,探讨CKD患者RDW对LVH的预测价值。方法选取2019年6月至12月在南通大学第二附属医院肾内科就诊的CKD患者共122例,根据LVMI水平分为两组:左心室肥厚组(A组,n=100),非左心室肥厚组(B组,n=22)。比较两组间统计指标的差异,两组LVMI水平与各项指标分别进行Pearson相关分析,多因素Logistic回归分析筛选CKD合并有LVH的独立相关因素。利用受试者工作特征曲线(ROC)判断RDW对CKD患者LVH的预测价值。结果A组的收缩压、RDW及血磷(P)明显高于B组,红细胞(RBC)、血红蛋白(Hb)及血钙(Ca)明显低于B组,差异均有统计学意义(P>0.05)。Pearson相关分析结果显示LVH与收缩压、RDW、P、甲状旁腺激素(PTH)等指标呈正相关(P>0.05),LVH与RBC、Hb等指标呈负相关(P>0.05)。多因素logistics回归分析发现RBC与RDW(>14%)是LVH的独立危险因素(OR=0.251,95%CI 0.077,0.823,P=0.022)。RDW水平预测CKD患者LVH的ROC曲线下面积为0.677(95%CI:0.545,0.809,P=0.009),敏感性为75.0%,特异性为63.6%。结论高RDW水平是LVH的独立危险因素。

Objective To study the correlation between red blood cell distribution width(RDW),left ventricular hypertrophy(LVH)and left ventricular myocardial mass index(LVMI)in patients with chronic kidney disease(CKD),and to explore the predictive value of RDW for LVH in patients with CKD.Methods A total of 122 CKD patients were collected from the Nephrology Department of the Second Affiliated Hospital of Nantong University from June to December 2019.According to the LVMI level,122 patients were divided into 2 groups:LVH group(group A,n=100)and non-LVH group(group B,n=22).The differences of statistical indicators between the 2 groups were compared.Pearson correlation analysis was performed according to LVMI levels and each index in the 2 groups.Multivariate logistic regression analysis was used to screen independent related factors of CKD combined with LVH.The predictive value of RDW for LVH in CKD patients was judged using receiver operating characteristic curve(ROC).Results The levels of systolic blood pressure,RDW,and blood phosphorus(P)of group A were significantly higher than group B,the levels of RBC,Hb and Ca were significantly lower than those in group B(all P>0.05).The results of Pearson correlation analysis showed that LVH was positively correlated with systolic blood pressure,RDW,P,parathyroid hormone(PTH)and other indicators(P>0.05),and LVH was negative with RBC and Hb(P>0.05).Multivariate logistic regression analysis found that RBC and RDW(>14%)were independent risk factors for LVH(OR=0.251,95%CI 0.077,0.823,P=0.022).RDW level predicts the area under the ROC curve of LVH in CKD patients is 0.677(95%CI:0.545,0.809,P=0.009),and the sensitivity and specificity were 75.0%and 63.6%,respectively.Conclusion High RDW level is an independent risk factor for LVH.