红细胞分布宽度联合超敏肌钙蛋白T对MHD患者左室舒张功能障碍的预测价值

Predictive Value of RDW Combined with hs-cTnT on Left Ventricular Diastolic Dysfunction in MHD Patients

【目的】探讨红细胞分布宽度(RDW)联合超敏肌钙蛋白T(hs-cTnT)对维持性血液透析(MHD)患者左室舒张功能障碍的预测价值。【方法】检测80例MHD患者透析前血清hs-cTnT及RDW水平,另采用多普勒超声检测患者透析前的二尖瓣舒张期早期波(E')及二尖瓣舒张期早期峰值流速(E)等,根据检测结果将其分为舒张障碍组及舒张正常组。以Logistic多因素回归分析影响MHD患者左室舒张功能障碍的相关因素,以受试者工作特征(ROC)曲线判定RDW及hs-cTnT水平对患者并发左室舒张功能障碍的预测价值。【结果】80例MHD患者中,左心室舒张功能障碍49例(61.25%),左心室舒张功能正常31例(38.75%)。舒张障碍组患者糖尿病史比例及RDW、水负荷、hs-cTnT水平均高于舒张正常组,超滤量/BMI水平低于舒张正常组(P<0.05)。Logistic多因素回归分析结果显示,有糖尿病史、RDW、水负荷及hs-cTnT表达水平高、超滤量/BMI表达水平低均为MHD患者出现左室舒张功能障碍的危险因素(P<0.05)。ROC分析显示,RDW及hs-cTnT单一及联合预测对MHD患者并发左室舒张功能障碍患者的曲线下面积(AUC)分别为0.804、0.807、0.888。RDW及hs-cTnT单一对患者并发左室舒张功能障碍的预测效能低于两者联合(P<0.05)。【结论】RDW、hs-cTnT表达水平高的MHD患者更易并发左室舒张功能障碍,且RDW、hs-cTnT对MHD患者并发左室舒张功能障碍具有一定的临床预测价值。

【Objective】To analyze the predictive value of red blood cell distribution width(RDW)combined with high-sensitivity troponin T(hs-cTnT)in maintenance hemodialysis(MHD)patients with left ventricular diastolic dysfunction.【Methods】A total of 80 MHD patients in our hospital from April 2019 to February 2021 were selected.The serum hs-cTnT level and RDW level of the patients before dialysis were collected.In addition,Doppler ultrasound was used to detect the early diastolic wave(E')and early diastolic peak flow rate(E)of the mitral valve.According to the test results,patients were divided into the diastolic dysfunction group and normal diastolic function group according to the test results.Logistic multivariate regression analysis was used to investigate the related factors affecting left ventricular diastolic dysfunction in patients;And receiver operating characteristic curve(ROC)was used to determine the effects of RDW and hs-cTnT levels on predictive value for patients to have complication with left ventricular diastolic disfunction.【Results】Among the 80 MDH patients,49 cases(61.25%)had left ventricular diastolic dysfunction,and 31 patients(38.75%)had normal left ventricular diastolic function.The diastolic dysfunction group has a higher proportion of diabetes history,RDW,water load,and hs-cTnT level compared to the normal diastolic group.The ultrafiltration volume/BMI level of the diastolic dysfunction group was lower than that of the normal diastolic group(P<0.05).Logistic multivariate regression analysis showed that a history of diabetes,RDW,high water load,hs-cTnT expression level and low ultrafiltration volume/BMI expression level were the risk factors for left ventricular diastolic dysfunction in MDH patients(P<0.05).ROC analysis showed that the area under the curve(AUC)of RDW and hs-cTnT single and combined predictions for patients with left ventricular diastolic dysfunction were 0.804,0.807,and 0.888,respectively.The predictive power of RDW and hs-cTnT alone on patients with left ventricular diastolic dysfunction was lower than that of the combination of the two measurements(P<0.05).【Conclusion】MHD patients with high expression levels of RDW and hs-cTnT are more likely to have left ventricular diastolic dysfunction.Thus,RDW and hs-cTnT have certain clinical predictive value for MHD patients with left ventricular diastolic dysfunction.