红细胞体积分布宽度与急性冠脉综合征患者冠脉病变程度的相关研究

发布时间：2018-08-04 12:54

【摘要】：目的:红细胞体积分布宽度(RDW)是血常规检测中常规的一部分,反映循环红细胞大小不均匀的信息,高RDW值反映红细胞(RBC)的体积变化较大。此参数已被证明是预测各种心血管疾病,如心力衰竭、稳定的冠状动脉疾病和急性心肌梗死(AMI)的发病率和死亡率的相关指标。本研究回顾性数据分析RDW在急性冠脉综合征(ACS)患者中的变化及与冠状动脉粥样硬化严重程度之间的相关性,同时分析ACS的独立危险因素,RDW与白细胞分类计数(WBC)之间的相关性,为RDW与ACS之间的相关性提供一个可能的发生机制。方法:回顾式随机选取2015年10月-2016年10月在陕西省人民医院心血管内科因“胸痛”就诊住院并行冠脉造影检查的216例患者。1.依据冠脉造影诊断、血清心肌酶学改变及病史分为ACS组患者163例;正常对照组53例,比较2组资料一般临床指标有无差异。2.ACS组依据临床类型不同分为:不稳定型心绞痛(UA)73例,非ST段抬高性心肌梗死(NSTEAMI)24例,ST段抬高型心肌梗死(STEAMI)66例。按照冠脉血管病变支数将ACS组分为单支血管病变组、双支血管病变组及多支血管病变组。依据冠脉造影术结果:病变累积血管的部位、血管病变支数、血管狭窄及弥漫程度行Gensini评分。探讨RDW、WBC和Gensini积分之间是否存在线性相关关系;以ACS发生与否作为因变量,进行二元logistic回归分析ACS发生的危险因素。结果:1.一般临床资料比较:(1)ACS组在吸烟、高血压病史、糖尿病病史、血肌酐中与对照组相比明显升高,ACS组男性多于对照组,P0.05;(2)在依据血管病变支数分三亚组间比较采用方差分析,在甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)等差异具有显著统计学意义。2.ACS组较对照组RDW水平明显升高(P0.01)。3.在不同血管病变支数的亚组中RDW随着血管病变支数的增加而升高。4.不同临床分型的三亚组及对照组RDW水平的比较,结果显示:UA组、NSTEAMI组、STEAMI组三组分别与对照组比较,RDW值明显升高,差异均有显著性意义,P0.01。STEAMI组分别与UA组比较,差异有显著性意义,P=0.006。UA组和STEAMI组分别于NSTEAMI组RDW均值比较,差异无显著性意义。5.Gensini积分与RDW和WBC之间的相关性分析,结果显示RDW及WBC与Gensini积分呈显著正相关,相关系数分别为(r=0.501,P0.001)和(r=0.379,P0.001);RDW与WBC也呈正相关,相关系数(r=0.361,P0.001)。6.ACS发生的危险因素的多元logistic回归分析结果显示:RDW、性别为ACS的独立危险因素,高密度脂蛋白胆固醇(HDL-C)为其保护性因素。结论:1、RDW水平在ACS组明显高于对照组。2、RDW值升高与冠脉病变严重程度(Gensini积分)呈正相关,表明RDW增高可反映冠状动脉病变的病变严重程度。3、logistic回归分析在控制了其他影响因素外,RDW升高为ACS的独立预测因子,HDL-C升高为其独立保护性因素。4、RDW升高与WBC呈显著正相关性,表明RDW增高可能与机体的慢性炎反应有关。
[Abstract]:Objective: erythrocyte volume distribution width (RDW) is a routine part of routine blood routine examination, which reflects the information of the uneven size of circulating red blood cells. The high RDW value reflects the volume change of erythrocyte (RBC). This parameter has been proved to be a predictor of morbidity and mortality of various cardiovascular diseases, such as heart failure, stable coronary artery disease and acute myocardial infarction (AMI). In this study, we retrospectively analyzed the changes of RDW in patients with acute coronary syndrome (ACS) and its correlation with the severity of coronary atherosclerosis, and analyzed the correlation between the independent risk factor of ACS and the leukocyte classification count (WBC). It provides a possible mechanism for the correlation between RDW and ACS. Methods: 216 patients with chest pain and coronary angiography were randomly selected from October 2015 to October 2016 in the Department of Cardiovascular Medicine of Shaanxi Provincial people's Hospital. According to the diagnosis of coronary angiography, the changes of serum myocardial enzymes and history were divided into three groups: ACS group (n = 163) and normal control group (n = 53). 2. According to clinical type, 73 patients with unstable angina pectoris (UA) were divided into two groups: unstable angina pectoris (UA). 24 patients with non-St segment elevation myocardial infarction (NSTEAMI) and 66 patients with St segment elevation myocardial infarction (STEAMI). According to the number of coronary artery lesion branches, the ACS group was divided into single vessel lesion group, double vessel disease group and multi vessel disease group. According to the results of coronary angiography, Gensini score was performed on the location, number of branches, stenosis and diffuse degree of the lesion. To explore whether there is a linear correlation between ACS and Gensini integral, and to analyze the risk factors of ACS by binary logistic regression analysis with ACS as dependent variable. The result is 1: 1. Comparison of general clinical data: (1) smoking, history of hypertension, history of diabetes, and serum creatinine in ACS group were significantly higher than those in control group (P 0.05); (2) ANOVA was used to compare the three subgroups according to the number of branches of vascular lesions. There was significant difference in triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C). 2. The RDW level in ACS group was significantly higher than that in control group (P0.01). In the subgroups with different branches of vascular lesions, RDW increased with the increase of the number of branches. 4. 4. The results showed that the levels of RDW in the three groups were significantly higher than those in the control group (P 0.01) and that in the control group was significantly higher than that in the UA group. There was no significant difference in the mean value of RDW between NSTEAMI group and STEAMI group. 5. There was no significant correlation between Gensini integral and RDW and WBC. The results showed that RDW, WBC and Gensini score were positively correlated. The correlation coefficients were (r = 0.501) and (r ~ (0.379) P ~ (0.001) respectively. The correlation coefficient (r = 0.361) was also positively correlated with WBC. 6. The multiple logistic regression analysis of the risk factors of ACS showed that the sex was the independent risk factor for ACS, and the high density lipoprotein cholesterol (HDL-C) was the protective factor. 6. The results of multiple logistic regression analysis showed that RDW was an independent risk factor for ACS, and high density lipoprotein cholesterol (HDL-C) was the protective factor. Conclusion the level of RDW in ACS group is significantly higher than that in control group. The increase of RDW is positively correlated with the severity of coronary artery disease (Gensini score). The results showed that the increase of RDW could reflect the severity of coronary artery disease. 3 logistic regression analysis showed that the increase of HDL-C was significantly correlated with the increase of WBC, which was the independent predictor of the increase of RDW to the level of ACS, and the increase of RDW was significantly correlated with WBC. It is suggested that the increase of RDW may be related to the chronic inflammation reaction of the body.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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