原发性高血压患者红细胞分布宽度与左心室肥厚的相关性

Relationship between red blood cell distribution width and left ventricular hypertrophy in patients with essential hypertension

目的探究原发性高血压患者红细胞分布宽度(RDW)与左心室肥厚的相关性。方法回顾性分析2014年8月至2016年8月在郑州大学第二附属医院心血管内科住院的686例原发性高血压患者,按左心室质量指数(LVMI)及相对室壁厚度(RWT)将其分为正常构型组(n=215)、向心性重构组(n=322)、向心性肥厚组(n=118)、离心性肥厚组(n=31),检测所有患者血脂、肝肾功能、空腹血糖、RDW、高敏C反应蛋白、氨基末端脑利尿钠肽前体及心脏彩色多普勒超声(彩超)相关指标,测量身高、体质量、血压,并计算体质量指数(BMI)、估算的肾小球滤过率(eGFR)、LVMI、RWT。应用有序多分类logistic回归分析RDW与左心室肥厚的关系,采用受试者工作特征(ROC)曲线评价RDW对左心室肥厚的判断价值。结果4组患者性别构成、年龄、体表面积、高血压分级、高血压危险分层、糖尿病、eGFR、胱抑素C、低密度脂蛋白胆固醇(LDL-C)、RDW、左心房内径(LAD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVDd)、E峰、左心室质量(LVM)、LVMI、RWT指标比较,差异有统计学意义(均P<0.05)。4组RDW比较,向心性肥厚组、离心性肥厚组高于正常构型组[(13.06±0.60)%、(13.48±0.32)%比(12.86±0.79)%],离心性肥厚组高于向心性重构组[(12.93±0.72)%]、向心性肥厚组(均P<0.05)。Pearson相关分析显示,RDW与eGFR呈负相关(r=-0.135),与年龄、胱抑素C、LAD、IVST、PWT、LVDd、LVM、LVMI呈正相关(分别r=0.150,0.125,0.162,0.159,0.132,0.110,0.176,0.175,均P<0.05)。有序多分类logistic回归分析结果显示,在校正了体表面积、糖尿病、IVST、LVPWT因素后,RDW仍是左心室肥厚的独立危险因素(与RDW>13%比较,RDW≤13%的OR=0.694,95%CI 0.493~0.976,P<0.05)。ROC曲线分析显示RDW≥13.15%是预测原发性高血压人群离心性肥厚的最佳切点,其敏感度为87.1%,特异度为69.5%,曲线下面积为0.808(95%CI 0.762~0.854,P<0.001)。结论原发性高血压患者RDW是左心室肥厚的独立危险因素,RDW≥13.15%提示离心性肥厚。

Objective To investigate the association between red blood cell distribution width(RDW)and left ventricular hypertrophy in patients with essential hypertension.Methods A retrospective analysis of 686 inpatients with essential hypertension in the Department of Cardiology of the Second Affiliated Hospital of Zhengzhou University from August 2014 to August 2016 were performed.Based on left ventricular mass index(LVMI)and relative wall thickness(RWT),patients were divided into normal geometry group(n=215),concentric remodeling group(n=322),eccentric hypertrophy group(n=118)and concentric hypertrophy group(n=31).Blood lipid level,hepatic function,renal function,fasting blood glucose,RDW,high-sensitivity C-reactive protein,and N-terminal pro-brain natriuretic peptide were detected and echocardiography were performed.The height,weight,and blood pressure were measured.Body mass index(BMI),estimated glomerular filtration rate(eGFR),LVMI and RWT were calculated.The relationship between RDW and left ventricular hypertrophy was analyzed by ordinal polytomous logistic regression analysis,and receiver operating characteristic(ROC)curve was applied to judge the value of RDW on confirming left ventricular hypertrophy.Results There were statistical differences(all P<0.05)in terms of gender,age,body surface area(BSA),classification and the risk stratification of hypertension,diabetes,eGFR,cystatin C,low-density lipoprotein cholesterol(LDL-C),RDW,left atrial diameter(LAD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end-diastolic diameter(LVDd),E peak,left ventricular mass(LVM),LVMI,and RWT among four groups.RDWs in concentric hypertrophy group[(13.06±0.60)%],eccentric hypertrophy group[(13.48±0.32)%]were higher than those in normal geometry group[(12.86±0.79)%].RDW in eccentric hypertrophy group was higher than that in concentric remodeling group[(12.93±0.72)%]and in concentric hypertrophy group(all P<0.05).Pearson correlation analysis suggested that RDW was negatively correlated with eGFR(r=-0.135)and positively correlated with age,cystatin C,LAD,IVST,LVPWT,LVDd,LVM and LVMI(r=0.150,0.125,0.162,0.159,0.132,0.110,0.176 and 0.175 respectively,all P<0.05).Ordinal polytomous logistic regression analysis demonstrated that RDW was an independent risk factor for left ventricular hypertrophy after adjusted for BSA,diabetes,IVST and LVPWT[compared with RDW>13%,OR=0.694(95%CI 0.493-0.976)for RDW≤13%,P<0.05].ROC curve illuminated that RDW value of 13.15%was identified as an effective cut-point in predicting the presence or absence of eccentric hypertrophy group with a sensitivity of 87.1%,a specificity of 69.5%,and area under the ROC curve of 0.808(95%CI 0.762-0.854,P<0.001).Conclusions RDW is an independent risk factor for left ventricular hypertrophy in patients with essential hypertension.RDW≥13.15%indicates eccentric hypertrophy.