高龄高血压患者红细胞分布宽度与靶器官损害的关系研究

孙晓楠; 赫明萍; 李玉龙; 王吉; 骆雷鸣; 赵晓茜

doi:10.3969/j.issn.2095-5227.2021.12.002

高龄高血压患者红细胞分布宽度与靶器官损害的关系研究

Relationship between red blood cell distribution width and target organ damage in senior elderly patients with hypertension

摘要

摘要:
背景既往研究显示红细胞分布宽度(red blood cell distribution width，RDW)作为一项血常规指标能够反映体内的炎症状态，而全身慢性炎症状态在高血压靶器官损伤中扮演重要角色。
目的探讨高龄高血压患者RDW与靶器官损伤的关系。
方法选取2016年1月- 2019年12月解放军总医院第二医学中心心内科就诊的80岁以上高血压患者，根据其RDW四分位间距水平进行分组，＜12.80%为第1组，12.80% ~ 13.30%为第2组，13.31% ~ 13.97%为第3组，＞13.97%为第4组，比较四组患者血常规指标、血生化指标、超声心动图参数及颈动脉超声参数。采用Pearson相关分析确定RDW与心室肥厚、心脏功能、肾功能的关系。
结果 RDW水平较高患者的年龄、三酰甘油及肌酐水平均偏高，估算肾小球滤过率水平偏低(P均＜0.05)；随着RDW水平升高，室间隔厚度及左心室后壁厚度(left ventricular posterior wall thickness，LVPWT)增加，左心室质量指数(left ventricular mass index，LVMI)也随之增加(P均＜0.05)；四组左心室肥厚发生率分别为6.45%、16.00%、16.83%和23.71%，发生率显著增加(P_for_trend=0.013)；RDW水平高的患者左心室射血分数(left ventricular ejection fraction，LVEF)降低，左心室缩短分数也随之降低(P均＜0.05)；不同RDW水平患者舒张功能差异无统计学意义(P＞0.05)；进一步相关分析显示RDW水平与LVPWT(r=0.684，P＜0.001)、LVMI呈显著正相关(r=0.623，P＜0.001)，与LVEF呈负相关(r=-0.218，P＜0.001)，与前白蛋白水平呈负相关(r=-0.537，P＜0.001)。RDW水平预测左心室肥厚发生的ROC曲线下面积为0.633(95% CI：0.553 ~ 0.708，P=0.001)。不同水平RDW患者颈动脉斑块发生率分别为57.1%、67.7%、76.6%和79.1％(P_for_trend=0.008)。
结论高龄高血压患者随着RDW水平升高，颈动脉斑块发生率增加，心脏收缩功能减退，心室肥厚发生率增加，营养状态变差，监测RDW水平对于筛查靶器官损伤的高危患者有一定意义。

Abstract:
Background Previous studies show that red blood cell distribution width (RDW) can reflect the inflammatory state in vivo, and the systemic chronic inflammatory state plays an important role in the target organ injury of hypertension.
Objective To explore the relationship between RDW and target organ damage in senior elderly patients with hypertension.
Methods All hypertensive patients aged over 80 years admitted to geriatric cardiovascular department of Chinese PLA General Hospital from January 2016 to December 2019 were enrolled and the subjects were divided into quartiles according RDW, quantile 1 (＜12.80%), quantile 2 (12.80%-13.30%), quantile 3(13.31%-13.97%) and quantile 4 (＞13.97%). Then blood routine test and biochemical indexes, echocardiography and carotid ultrasound parameters in patients of the four groups were measured. Pearson correlation analysis was used to determine the relationship among RDW and ventricular hypertrophy, cardiac function, renal function.
Results The patients with higher RDW level were older and had higher TG and creatinine levels, lower estimated glomerular filtration rate (all P < 0.05). With the increase of RDW level, the interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT) increased, so did left ventricular mass index (LVMI). The incidence of left ventricular hypertrophy of four groups were 6.45%, 16.00%, 16.83% and 23.71%, respectively, and it increased significantly with the increase of RDW (P_for_trend=0.013). The left ventricular ejection fraction (LVEF) as well as fractional shortening (FS) decreased in patients with higher RDW level (P < 0.05, respectively), however, the diastolic function showed no significant difference in patients with different RDW levels (P > 0.05). Further correlation analysis showed that RDW was positively correlated with LVPWT (r=0.684, P＜0.001) and LVMI (r=0.623, P＜0.001), while it was negatively correlated with LVEF (r=-0.218, P＜0.001) and prealbumin (r=-0.537, P＜0.001). The AUC of RDW in predicting left ventricular hypertrophy was 0.633 (95% CI: 0.553 - 0.708, P=0.001). The incidence of carotid plaque in patients with different levels of RDW was 57.1%, 67.7%, 76.6% and 79.1%, respectively (P_for_trend=0.008).
Conclusion With the increase of RDW, the incidence of carotid plaque and ventricular hypertrophy increases in senior elderly hypertensive patients, while the cardiac systolic function decreases, and the nutritional status is poor. Monitoring RDW level can help to screen out high-risk patients with target organ damage.

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