【摘要】目的：探讨红细胞分布宽度(red blood cell distribution width，RDW)与血液透析患者并发急性心力衰竭(acute heart failure, AHF)之间的关系。方法回顾性分析在武汉科技大学附属孝感医院血液净化中心行血液透析患者共180 例，收集患者的一般资料及实验室指标，将患者分为AHF组(n=78)和非AHF 组(n=102)，分别进行2 组间一般资料与临床指标的比较，分析AHF与RDW 以及其他临床指标的相关性。结果与非AHF 组相比，AHF 组患者有更高水平的RDW(t=-9.042, P＜0.001)。Spearman 相关性分析显示，RDW (r=0.584, P＜0.001)、超敏C 反应蛋白(r=0.219, P=0.003)与AHF 呈正相关；而白蛋白(r=0.159, P=0.033)与AHF 呈负相关。多因素Logistic 回归分析显示RDW(OR=5.763，95%CI 3.334～9.961，P＜0.001)、白蛋白(OR=1.104，95%CI 0.984～1.238，P=0.091)、超敏C 反应蛋白(OR=1.065，95%CI 1.002～1.133，P=0.044)是AHF 的危险因素。ROC 曲线分析显示RDW 预测AHF 的曲线下面积为0.840，灵敏度为74.4%，特异度为83.3%。结论RDW 是血液透析并发AHF 患者的危险因素，对血液透析患者并发AHF有一定的预测价值。
【Abstract】Objective To investigate the relationship between red blood cell distribution width (RDW) and acute heart failure (AHF)) in hemodialysis patients. Methods A total of 180 hemodialysis patients treated in the Blood Purification Center, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology were retrospectively analyzed. They were divided into AHF group (n=78) and non AHF group (n=102). Their general information and laboratory indexes were recruited and compared between the two groups. The correlation between AHF and RDW and other clinical indicators was analyzed. Results Patients in the AHF group had higher RDW (14.96±0.81)% as compared with that in the non-AHF group (t=-9.042, P<0.001). Pearson
correlation analysis showed that RDW (r=0.584, P<0.001) and hypersensitive C- reactive protein (r=0.219, P=0.003) were positively correlated with AHF, and albumin (r=0.159, P=0.033) was negatively correlated with AHF. Multivariate logistic regression analysis revealed that RDW (OR=5.763, 95% CI 3.334～9.961, P<0.001), albumin (OR=1.104, 95% CI 0.984～1.238, P=0.091), and hypersensitive C- reactive protein (OR=1.065, 95% CI 1.002～1.133, P=0.044) were the risk factors for AHF. ROC curve analysis found that the area under curve (AUC) of RDW for predicting AHF was 0.840, with the sensitivity of 74.4% and specificity
of 83.3%. Conclusion Higher RDW is a risk factor and a predictive indicator for hemodialysis patients complicated with AHF.
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