红细胞分布宽度对急性心肌梗死合并多支血管病变患者远期预后的预测价值

Predictive value of red blood cell distribution width for long-term prognosis in patients with acute myocardial infarction complicated with multi-vessel disease

目的红细胞分布宽度比值(RDW)对急性心肌梗死(AMI)合并多支血管病变(MVD)患者远期预后的预测价值。方法选取2012年6月至2014年8月西藏自治区人民政府驻成都办事处医院心内科收治的确诊为AMI合并MVD患者262例作为研究对象,所有患者随访5年,根据是否发生主要不良心血管事件(MACE)将患者分为MACE组和非MACE组;采用多因素Logistic回归分析筛选患者预后发生MACE的危险因素;采用ROC曲线评价RDW对患者预后发生MACE的预测价值。结果MACE组和非MACE组之间心率、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、纤维蛋白原(Fib)、白蛋白(Alb)、左心室射血分数(LVEF)、纽约心脏病协会心功能(NYHA)分级、Gensini评分及RDW比较,差异有统计学意义(t/χ^(2)=6.365、15.289、5.290、8.294、2.438、13.437、29.497、10.484、18.263,P<0.05);多因素Logistic回归分析结果显示,LDL-C、Fib、LVEF、NYHA分级、Gensini评分及RDW是发生MACE的危险因素[OR(95%CI)=2.022(1.987~2.983)、1.622(1.311~2.215)、1.343(1.264~1.846)、5.826(2.189~6.292)、1.432(1.124~5.495)、1.681(1.257~6.743),P<0.05];ROC曲线显示,RDW对AMI合并MVD患者经皮冠状动脉介入术后MACE的曲线下面积为0.834,敏感度为84.38%,特异度为72.39%,具有较高的预测价值。结论RDW是AMI合并MVD患者远期预后发生MACE的影响因素,且具有较高的预测价值,对临床尽早采取合适治疗方案、改善长期预后具有参考价值。

Objective To investigate the predictive value of red cell volume distribution width(RDW)for long-term prognosis in patients with acute myocardial infarction(AMI)complicated with multivessel disease(MVD).Methods A total of 262 patients with AMI complicated with MVD who were admitted to the department of cardiology of the Hospital of the People's Government of Tibet Autonomous Region in Chengdu from June 2012 to August 2014 were selected as the research subjects.All the patients were followed up for 5 years,and they were divided into MACE group and non-MACE group according to whether a major adverse cardiovascular event(MACE)had occurred.Multivariate Logistic regression analysis was used to screen the risk factors for MACE.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of RDW in MACE.Results There were statistically significant differences in heart rate,low density lipoprotein cholesterol(LDL-C),triglyceride(TG),fibrinogen(Fib),albumin(Alb),left ventricular ejection fraction(LVEF),New York heart academy(NYHA)cardiac function grading,Gensini score and RDW between MACE group and non-MACE group(t/χ^(2)=6.365,15.289,5.290,8.294,2.438,13.437,29.497,10.484,18.263;P<0.05).Multivariate Logistic regression analysis showed that LDL-C,FIB,LVEF,NYHA cardiac function grade,Gentsini score and RDW were risk factors of MACE[OR(95%CI)=2.022(1.987-2.983),1.622(1.311-2.215),1.343(1.264-1.846),5.826(2.189-6.292),1.432(1.124-5.495),1.681(1.257-6.743);P<0.05].The ROC curve showed that the area under the curve,sensitivity and specificity of RDW for MACE after percutaneous coronary intervention in AMI patients complicated with MVD were 0.834,84.38%and 72.39%,respectively,which had high predictive value.Conclusion RDW is an influencing factor of MACE in the long-term prognosis of AMI patients complicated with MVD,which has high predictive value and reference value for taking appropriate treatment plan as soon as possible and improving long-term prognosis.