红细胞分布宽度与慢性心力衰竭的相关性研究

Correlation between red blood cell distribution width and chronic heart failure

摘要:

目的 探讨慢性心力衰竭（CHF）患者红细胞分布宽度（RDW）与心脏收缩功能的关系及相关机制。 方法 选取2016 年9 月—2018 年5 月于山西医科大学附属汾阳医院心血管内科住院的慢性心力衰竭患者136 例。依据RDW 水平将患者分为低RDW 组（<13.2%）、中RDW 组（13.2% ～ <14.5%）和高RDW 组（≥ 14.5%）。 比较各组患者无创心脏血流动力指标，比较红细胞膜Na+-K+-ATPase、Ca2+-Mg2+-ATPase 活性。结果 高 RDW 组血红蛋白低于低RDW 组（P <0.05），高RDW 组Log NT-proBNP 水平高于低RDW 组（P <0.05）。 高RDW 组左室射血分数（LVEF）、心输出量（CO）、心指数（CI）、收缩指数、左室每分做功指数及每搏 做功指数较中RDW 组低（P <0.05），中RDW 组较低RDW 组低（P <0.05）。高RDW 组红细胞膜Na+- K+-ATPase 和Ca2+-Mg2+-ATPase 活性较中RDW 组低（P <0.05），中RDW 组较低RDW 组低（P <0.05）。 Pearson 相关分析显示，CHF 患者RDW 与LVEF、每搏输出量、CO、CI、最大射血速率、收缩指数、收缩 功能指数、左室每搏做功指数、左室做功指数及心功能指数呈负相关（r =-0.355、-0.184、-0.264、-0.276、 -0.244、-0.267、-0.221、-0.199、-0.298 和-0.316，P <0.05）；RDW 与红细胞膜Na+-K+-ATPase 活性、红细 胞膜Ca2+-Mg2+-ATPase 活性均呈负相关（r =-0.822 和-0.737，均P <0.05）。结论 CHF 患者的血流动力学收 缩功能参数与RDW 呈负相关，红细胞膜Na+-K+-ATPase、Ca2+-Mg2+-ATPase 活性下降可能是其原因之一。

Abstract:

Objective To investigate the relationship between red blood cell distribution width (RDW) and cardiac systolic function in patients with chronic Heart Failure (CHF) and its mechanism. Methods A total of 136 patients with chronic heart failure hospitalized in the department of cardiovascular medicine of Fenyang hospital from September 2016 to May 2018 were divided into three groups: low RDW group (<13.2%, 43 cases), middle RDW group (<13.2% to 14.5%, 47 cases) and high RDW group (>14.5%, 46 cases). The noninvasive cardiac hemodynamic parameters were compared among the three groups, and the activity of Na+-K+- ATPase and Ca2+-Mg2+-ATPase in erythrocyte membrane were compared. Results Hemoglobin in high RDW group was lower than that in low RDW group (P < 0.05), and the level of log NT proBNP in high RDW group was higher than that in low RDW group (P < 0.05). The left ventricular ejection fraction (LVEF), cardiac output (CO), cardiac index (CI), systolic index, left ventricular work per minute and work per beat index in the high RDW group were lower than those in the middle RDW group (P < 0.05), and those in the middle RDW group were lower than those in the low RDW group (P < 0.05). The activity of Na+-K+-ATPase and Ca2+-Mg2+-ATPase in the high RDW group was lower than that in the middle RDW group (P < 0.05), and that in the middle RDW group was lower than that in the low RDW group (P < 0.05).Pearson linear correlation analysis showed that RDW in CHF patients was negatively correlated with LVEF (r = -0.3551), SV (r = -0.1841), CO (r = -0.2640), CI (r = -0.2763), AMPC (r = -0.2437), IC (r = -0.2669), HI (r = -0.2213), SW (r = -0.1987), CW (r = -0.2975) and CWI (r = -0.3156) (all P < 0.05); RDW was negatively correlated with the activity of Na+-K+-ATPase (r = -0.8216) and Ca2+-Mg2+-ATPase (r = -0.7366) of erythrocyte membrane (all P < 0.05). Conclusions The hemodynamic parameters of CHF patients were negatively correlated with RDW. The decrease of Na+-K+- ATPase and Ca2+-Mg2+-ATPase activity in erythrocyte membrane may be one of the reasons.