原发性高血压患者红细胞分布宽度与Framingham心血管评分风险等级的关系

发布时间：2019-04-23 08:05

【摘要】：目的高血压病以进行性动脉血压持续升高为临床特征,可引起心、脑、肾、眼等重要靶器官损害。近年来,多项临床研究发现红细胞分布宽度(RDW)与急性冠状动脉综合征(ACS)、心力衰竭(HF)、心房颤动(AF)、肾小球滤过率(GFR)、肺动脉高压等关系密切,而其与原发性高血压患者心血管风险的关系研究甚少。本研究旨在探讨原发性高血压患者RDW与Framingham心血管危险评分风险等级的相关性。方法入选2014年9月至2016年8月在郑州大学第二附属医院心内科门诊及住院收治的原发性高血压患者383例,按Framingham心血管危险评分划分的风险等级将其分为低危组(n=176)、中危组(n=121)和高危组(n=86),另设正常血压对照组80例,检测所有患者血脂、肝肾功能、空腹血糖、RDW、高敏C反应蛋白(hs-CRP)及左心室射血分数(LVEF)值,测量身高、体质量、血压,并计算体质量指数(BMI)。应用有序多分类Logistic回归分析RDW与Framingham评分风险等级的关系,采用受试者工作特征(ROC)曲线评价RDW对心血管高危人群的判断价值。结果4组研究对象性别构成、丙氨酸氨基转移酶(ALT)、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、血肌酐、空腹血糖、LVEF值等指标比较,差异无统计学意义(均P0.05)。4组患者年龄、BMI、吸烟、糖尿病、服用他汀情况、收缩压、舒张压、低密度脂蛋白胆固醇(LDL-C)、胱抑素C(Cys-C)、RDW、hs-CRP等指标比较,差异有统计学意义(均P0.05)。4组RDW比较,高危组高于中危组[(13.42±0.92)%比(12.96±0.50)%],高危组、中危组高于低危组[(12.83±0.51)%]和对照组[(12.69±0.66)%](均P0.05)。Pearson相关分析显示RDW与LDL-C(r=-0.105)呈负相关,与年龄、Cys-C、hs-CRP、Framingham心血管风险呈正相关(分别r=0.182,0.151,0.566,0.312,均P0.05)。有序多分类Logistic回归分析结果显示,在校正了年龄、BMI、吸烟、糖尿病、服用他汀情况、收缩压、舒张压、LDL-C、Cys-C、hs-CRP等因素后,RDW仍是Framingham心血管评分风险等级的独立危险因素(OR=5.601,95%CI:1.557-20.146,P0.05)。ROC曲线分析示RDW 12.95%是预测心血管高危人群的最佳截断点,其灵敏度为75.6%,特异度为63.9%,ROC曲线下面积为0.735(95%CI:0.676-0.793,P0.001)。结论1.原发性高血压患者RDW明显高于血压正常人群。2.高RDW(12.95%)水平是心血管高危人群的一个独立预测指标。3.原发性高血压患者RDW可能与心血管风险等级相关。
[Abstract]:Objective Hypertension is characterized by continuous elevation of arterial blood pressure, which can cause damage to heart, brain, kidney, eye and other important target organs. In recent years, many clinical studies have found that red blood cell distribution width (RDW) is closely related to (AF), glomerular filtration rate (AF),) and pulmonary hypertension (GFR),) in patients with acute coronary syndrome (ACS),) heart failure (HF),) and atrial fibrillation (HF),). However, there is little research on the relationship between it and cardiovascular risk in patients with essential hypertension. The purpose of this study was to investigate the correlation between RDW and risk grade of Framingham cardiovascular risk score in patients with essential hypertension. Methods from September 2014 to August 2016, 383 patients with essential hypertension were enrolled in the Department of Cardiology, the second affiliated Hospital of Zhengzhou University. They were divided into low-risk group (n = 176) according to the risk grade of Framingham cardiovascular risk score. The blood lipid, liver and kidney function, fasting blood glucose, RDW,-Gao Min C-reactive protein (hs-CRP) and left ventricular ejection fraction (LVEF) were measured in 80 normal blood pressure control group (n = 80) and middle risk group (n = 121) and high risk group (n = 86). Body mass, blood pressure, and body mass index (BMI). The relationship between RDW and risk grade of Framingham score was analyzed by ordered multi-classification Logistic regression, and the diagnostic value of RDW to cardiovascular high-risk population was evaluated by using the (ROC) curve of receiver operating characteristics. Results the sex composition, alanine aminotransferase (ALT),) total cholesterol, triacylglycerol, high density lipoprotein cholesterol (HDL-C), serum creatinine, fasting blood glucose and LVEF were compared among the four groups. There was no significant difference in age, BMI, smoking, diabetes mellitus, statins use, systolic blood pressure, diastolic blood pressure, low density lipoprotein cholesterol (LDL-C), cystatin C (Cys-C), RDW,), systolic blood pressure (SBP), diastolic blood pressure (DBP), low density lipoprotein cholesterol (LDL-C). Hs-CRP and other indexes were significantly higher in the high-risk group than in the middle-risk group [(13.42 卤0.92)% vs (12.96 卤0.50)%], in the high-risk group [(13.42 卤0.92)% vs (12.96 卤0.50)%], in the high-risk group, and in the high-risk group. The median risk group was higher than the low risk group [(12.83 卤0.51)%] and the control group [(12.69 卤0.66)%] (all P0.05). Pearson correlation analysis showed that RDW was negatively correlated with LDL-C (r = 0.105), but negatively correlated with age and Cys-C,hs-CRP,. The cardiovascular risk of Framingham was positively correlated (r = 0.182, 0.151, 0.566, 0.312, P 0.05). Ordered multi-classification Logistic regression analysis showed that after adjusting for age, BMI, smoking, diabetes, statins use, systolic blood pressure, diastolic blood pressure, LDL-C,Cys-C,hs-CRP, and other factors, such as age, smoking, diabetes, statins, systolic pressure, diastolic blood pressure, and so on, RDW is still an independent risk factor (OR=5.601,95%CI:1.557-20.146,P0.05) for Framingham cardiovascular risk rating. Roc curve analysis shows that RDW 12.95% is the best cut-off point for predicting cardiovascular risk groups. The sensitivity and specificity were 75.6% and 63.9%, respectively. The area under the curve was 0.735 (95% CI / 0.676 / 0.793, P0.001). Conclusion 1. RDW in patients with essential hypertension was significantly higher than that in normotensive subjects. 2. High RDW (12.95%) is an independent predictor of cardiovascular risk. 3. RDW may be associated with cardiovascular risk levels in patients with essential hypertension.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.11

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