原發(fā)性高血壓患者紅細胞分布寬度與Framingham心血管評分風(fēng)險等級的關(guān)系
發(fā)布時間：2019-04-23 08:05
【摘要】：目的高血壓病以進行性動脈血壓持續(xù)升高為臨床特征,可引起心、腦、腎、眼等重要靶器官損害。近年來,多項臨床研究發(fā)現(xiàn)紅細胞分布寬度(RDW)與急性冠狀動脈綜合征(ACS)、心力衰竭(HF)、心房顫動(AF)、腎小球濾過率(GFR)、肺動脈高壓等關(guān)系密切,而其與原發(fā)性高血壓患者心血管風(fēng)險的關(guān)系研究甚少。本研究旨在探討原發(fā)性高血壓患者RDW與Framingham心血管危險評分風(fēng)險等級的相關(guān)性。方法入選2014年9月至2016年8月在鄭州大學(xué)第二附屬醫(yī)院心內(nèi)科門診及住院收治的原發(fā)性高血壓患者383例,按Framingham心血管危險評分劃分的風(fēng)險等級將其分為低危組(n=176)、中危組(n=121)和高危組(n=86),另設(shè)正常血壓對照組80例,檢測所有患者血脂、肝腎功能、空腹血糖、RDW、高敏C反應(yīng)蛋白(hs-CRP)及左心室射血分?jǐn)?shù)(LVEF)值,測量身高、體質(zhì)量、血壓,并計算體質(zhì)量指數(shù)(BMI)。應(yīng)用有序多分類Logistic回歸分析RDW與Framingham評分風(fēng)險等級的關(guān)系,采用受試者工作特征(ROC)曲線評價RDW對心血管高危人群的判斷價值。結(jié)果4組研究對象性別構(gòu)成、丙氨酸氨基轉(zhuǎn)移酶(ALT)、總膽固醇、三酰甘油、高密度脂蛋白膽固醇(HDL-C)、血肌酐、空腹血糖、LVEF值等指標(biāo)比較,差異無統(tǒng)計學(xué)意義(均P0.05)。4組患者年齡、BMI、吸煙、糖尿病、服用他汀情況、收縮壓、舒張壓、低密度脂蛋白膽固醇(LDL-C)、胱抑素C(Cys-C)、RDW、hs-CRP等指標(biāo)比較,差異有統(tǒng)計學(xué)意義(均P0.05)。4組RDW比較,高危組高于中危組[(13.42±0.92)%比(12.96±0.50)%],高危組、中危組高于低危組[(12.83±0.51)%]和對照組[(12.69±0.66)%](均P0.05)。Pearson相關(guān)分析顯示RDW與LDL-C(r=-0.105)呈負(fù)相關(guān),與年齡、Cys-C、hs-CRP、Framingham心血管風(fēng)險呈正相關(guān)(分別r=0.182,0.151,0.566,0.312,均P0.05)。有序多分類Logistic回歸分析結(jié)果顯示,在校正了年齡、BMI、吸煙、糖尿病、服用他汀情況、收縮壓、舒張壓、LDL-C、Cys-C、hs-CRP等因素后,RDW仍是Framingham心血管評分風(fēng)險等級的獨立危險因素(OR=5.601,95%CI:1.557-20.146,P0.05)。ROC曲線分析示RDW 12.95%是預(yù)測心血管高危人群的最佳截斷點,其靈敏度為75.6%,特異度為63.9%,ROC曲線下面積為0.735(95%CI:0.676-0.793,P0.001)。結(jié)論1.原發(fā)性高血壓患者RDW明顯高于血壓正常人群。2.高RDW(12.95%)水平是心血管高危人群的一個獨立預(yù)測指標(biāo)。3.原發(fā)性高血壓患者RDW可能與心血管風(fēng)險等級相關(guān)。
[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 鹵0.92)% vs (12.96 鹵0.50)%], in the high-risk group [(13.42 鹵0.92)% vs (12.96 鹵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 鹵0.51)%] and the control group [(12.69 鹵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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.11
本文編號：2463276
[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 鹵0.92)% vs (12.96 鹵0.50)%], in the high-risk group [(13.42 鹵0.92)% vs (12.96 鹵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 鹵0.51)%] and the control group [(12.69 鹵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.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R544.11
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