红细胞分布宽度联合混合动静脉血氧饱和度差对肺高压患者预后评估

Combination of red cell distribution width with mixed venous-to-arterial SvO_(2) difference for prognosis in pulmonary hypertension

目的观察分析联合检测红细胞分布宽度(RDW)及混合动静脉血氧饱和度差(Sa-vO_(2))与肺高压(PH)患者预后的相关性。方法回顾性分析2015年1月至2016年9月我院收治的186例PH患者临床资料,收集并分析基线水平RDW与超声心动图、实验室检查及心导管参数的相关性。所有患者随访2年,根据ROC曲线判断PH患者RDW和Sa-vO_(2)水平的临界值,Cox回归分析各观察指标预测预后的价值,Kaplan-Meier生存曲线分析患者的生存预后。结果 RDW与世界卫生组织心功能分级、总胆红素、尿酸、N末端B型利钠肽原、肺血管阻力指数、Sa-vO_(2)存在显著正相关性,与左心室射血分数、动脉血氧饱和度、混合静脉血氧饱和度(SvO_(2))存在显著负相关性。RDW、Sa-vO_(2)、联合RDW及Sa-vO_(2)曲线下面积分别为0.669、0.708和0.725,P<0.05。当RDW=14.01%及Sa-vO_(2)=29.1%时,预测PH患者预后不良事件敏感度和特异度分别为72.5%和57%。Cox回归分析显示,当患者为高风险组(RDW≥14.01%且Sa-vO_(2)≥29.1%)时,发生不良事件的风险是低风险组(RDW<14.01%并且Sa-vO_(2)<29.1%)的6.5倍。结论 RDW可用于PH患者病情评估,联合混合动静脉血样饱和度差对预测预后具有积极意义。

Objective To analysis the relationship between the combination of red cell distribution width(RDW) with mixed venous-to-arterial SvO_(2)difference(Sa-vO_(2)) and prognosis of the patients with pulmonary hypertension(PH). Methods A total of 186 patients with PH from January 2015 to September 2019 were collected. The data of RDW, cardiac Doppler examination, laboratory examination and cardiac catheterization were analyzed. All patients were followed up for 2 years. According to ROC, the cut-off values of RDW and Sa-vO_(2)were determined. Cox regression was used to analyze the prognostic value of each index. Kaplan-Meier survival curve was used to analyze the survival prognosis of PH patients. Results RDW had a positive correlation with the World Health Organization heart functional class, total bilirubin, uric acid, N-terminal pro-brain natriuretic peptide,pulmonary vascular resistance index and Sa-vO_(2), and showed a negative correlation withleft ventricular ejection and arterial oxygen saturation. The AUC of RDW、Sa-vO_(2)and combined RDW with Sa-vO_(2)were 0.669 0.708 and0.725 respectively(P<0.05). When RDW=14.01% and Sa-vO_(2)=29.1%, the sensitivity and specificity of adverse events were 72.5% and 57% respectively. Cox regression analysis showed that when patients were in the high-risk group(RDW≥14.01% and Sa-vO_(2)≥29.1%), the risk of adverse events was 6.5 times higher than that in the low-risk group(RDW<14.01% and Sa-vO_(2)<29.1%). Conclusion RDW could be used to assess the condition of patients with PH. Combined RDW with Sa-vO_(2)has a positive significance in predicting prognosis.