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目的:探讨红细胞分布宽度(RDW)对接受心脏再同步化治疗(CRT)的心力衰竭(心衰)患者临床预后的影响及相关因素分析。方法:回顾性调查在本院行首次CRT植入术的264例心衰患者临床资料。定义随访终点为全因死亡(包括心脏移植)和心衰再住院。以CRT植入术后1年内全因死亡为因变量绘制受试者工作特征(ROC)曲线,根据敏感度和特异度之和最大值找到RDW的最佳界值(cut-off值)。以RDW的最佳界值将患者分为2组,对基线资料行相关性分析,对随访结果做Kaplan-Meier生存分析和Cox回归,并评价RDW对各临床终点事件的预测价值。结果:ROC曲线预测患者1年内全因死亡的RDW界值为13.75%(P=0.006,曲线下面积0.638,敏感度0.538,特异度0.747)。相关性分析显示,RDW与高敏C反应蛋白(hsCRP)、左房前后径(LAd)呈正相关(r=0.233,P<0.01;r=0.289,P<0.01)。RDW≥13.75%组纽约心脏病学会(NYHA)分级高于RDW<13.75%组。Kaplan-Meier生存曲线显示,在全因死亡和心衰再住院方面RDW≥13.75%组均明显劣于RDW<13.75%组(log-rank检验:P<0.01;P=0.006)。单因素及多因素Cox回归在校正年龄和性别后,RDW≥13.75%(HR=2.078,95%CI:1.014~4.262,P=0.046)仍是CRT患者全因死亡的独立危险因素,但在心衰再住院方面无统计学意义(HR=1.386,95%CI:0.833~2.306,P=0.209);LAd(HR=1.038,95%CI:1.003~1.074,P=0.031)是心衰再住院的独立危险因素。结论:RDW与患者的心衰严重程度相关。RDW≥13.75%提示CRT患者远期死亡及心脏移植风险增加。
Objective: To investigate the effect of RDW on the clinical prognosis of heart failure (HF) patients undergoing cardiac resynchronization therapy (CRT) and analyze the related factors. Methods: The clinical data of 264 patients with heart failure undergoing CRT implantation at our hospital were retrospectively reviewed. Defined follow-up for all-cause death (including heart transplant) and heart failure and hospitalization. The ROC curve of all-cause mortality was established as the dependent variable within one year after CRT implantation. The best cut-off value of RDW was found based on the sum of sensitivity and specificity. The patients were divided into two groups according to the best value of RDW. The correlations of baseline data were analyzed. Kaplan-Meier survival analysis and Cox regression were performed on the follow-up results. The predictive value of RDW for each clinical endpoint was also evaluated. Results: The RDW cutoff of ROC curve for all-cause death within one year was 13.75% (P = 0.006, area under the curve 0.638, sensitivity 0.538, specificity 0.747). Correlation analysis showed that RDW was positively correlated with hsCRP and LAd (r = 0.233, P <0.01; r = 0.289, P <0.01). RDW≥13.75% The New York Heart Association (NYHA) was higher than RDW <13.75%. The Kaplan-Meier survival curves showed that RDW≥13.75% was significantly worse than RDF <13.75% in all-cause death and HF-rehospitalization (log-rank test: P <0.01; P = 0.006). Univariate and multivariate Cox regression showed that RDW≥13.75% (HR = 2.078,95% CI: 1.014 ~ 4.262, P = 0.046) was still an independent risk factor for all-cause mortality in CRT patients after adjusting for age and gender. However, (HR = 1.386, 95% CI: 0.833-2.306, P = 0.209); LAd (HR = 1.038, 95% CI: 1.003-1.074, P = 0.031) Independent risk factors. Conclusion: RDW is associated with the severity of heart failure in patients. RDW ≥13.75% prompted long-term death of CRT patients and increased risk of heart transplantation.