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论著:急性心肌梗死患者红细胞分布宽度与N末端脑钠肽前体的关系研究
Relationship between the Levels of N-Terminal Pro-Brain Natriuretic Peptide and Red Blood Cell Distribution Width in Acute Myocardial Infarction Patients
徐磊 潘文志 弭守玲 葛均波
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作者单位:复旦大学附属中山医院心内科
中文关键字:红细胞分布宽度;急性心梗;N末端脑钠肽前体;C反应蛋白
英文关键字:Red cell distribution width; Acute myocardial infarction; N-terminal pro-brain natriuretic peptide; C-reactive protein
中文摘要:目的:红细胞分布宽度(RDW)越高,急性心肌梗死(AMI)患者预后越差,本研究探讨AMI患者RDW升高的内在机制。方法:102例确诊AMI患者(AMI组)、与150例稳定性冠心病的患者(CAD组)。所有入选者均检测RDW、高敏C反应蛋白(hsCRP)和N末端脑钠肽前体(NT-proBNP),比较AMI组与CAD组RDW、hsCRP、NT-proBNP的差异。结果:CAD组的RDW显著低于AMI组(13.0%±0.7% 比 13.3%±0.9%; P=0.003),但校正NT-proBNP后,2组间RDW水平的差异无统计学意义(P=0.488)。单变量线性相关及多变量分析提示,NT-proBNP而非hsCRP是RDW的独立预测因子。将入院第7天与入院第1天测得的变量差值进行分析发现,RDW的差值(△RDW)与NT-proBNP的对数差值(△log NT-proBNP)具有相关性。△RDW对NT-proBNP的变化具有中度预测价值(曲线下面积为0.71±0.05; P<0.01)。结论:NT-proBNP而非hsCRP与AMI患者中RDW呈正相关,即心梗后心功能的恶化可能是导致患者RDW升高的主要原因。
英文摘要:Objective: The mechanism underlying the association between higher red cell distribution width (RDW) and worse outcomes in acute myocardial infarction (AMI) patients is unknown. We hypothesized that RDW levels are increased by poor cardiac function and inflammation. We conducted a study to observe the relationship between RDW and N-terminal pro-brain natriuretic peptide (NT-proBNP) as well as C-reactive protein (CRP) in AMI patients. Methods: A total of 102 patients with a diagnosis of AMI were eligible for the AMI group, while 150 patients with stable coronary artery disease (CAD) were enrolled as control group. High-sensitivity CRP (hsCRP), RDW and NT-proBNP were measured, while the relationships between RDW to NT-proBNP and hsCRP were analyzed. Results: RDW in CAD group was lower than in AMI group (13.0%±0.7% vs. 13.3%±0.9%; P=0.003). However, after adjusting for NT-proBNP, there was no difference of RDW between the both groups (P=0.488). Univariate linear correlation analysis and multi-variate analysis revealed that NT-proBNP but not hsCRP was an independent predictor of RDW. When analyzing the relation between the absolute change of variable (△variable = variable measured on the 7th day - variable measured on the 1st day), we found that △RDW was correlated with △log(NT-proBNP) (R=0.33, P<0.001) rather than △ log(hsCRP)(P>0.05). △RDW had a moderate ability to predict change of NT-proBNP (area under the curve 0.71±0.05; P<0.01). Conclusions: Elevated NT-proBNP instead of high hsCRP is associated with higher RDW in AMI patients.
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