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目的探讨高血压和冠状动脉性心脏病(冠心病)患者红细胞分布宽度(RDW)的变化以及RDW与心脏结构和功能的关系。方法选择高血压患者305例,根据冠状动脉造影结果,将患者分为两组:高血压并冠心病组(EH+冠心病组);原发性高血压组(EH组)。对两组相关临床资料、超声心动图检查结果以及冠心病的影响因素进行分析比较。结果同性别相比,EH+冠心病组患者RDW明显高于EH组患者[男:(13.77±0.91)%比(13.44±0.73)%;女:(13.74±0.67)%比(13.44±0.74)%;均P<0.01]。EH+冠心病患者左心房内径(LAD)和左心室舒张未期内径(LVEDd)大于EH患者(均P<0.01),左心室后壁厚度(LVPWT)和左心室射血分数(LVEF)均低于EH患者(P<0.05,P<0.01)。两组患者室间隔厚度(IVS)及左心室质量指数(LVMI)无明显差异(P>0.05)。Pearson相关分析表明,RDW与左心室结构和功能指标均无相关。冠心病影响因素的logistic回归分析显示,高血压患者发生冠心病的危险与年龄、性别、吸烟及RDW明显相关[OR分别为1.05(每10岁)、0.42(女性)、2.00及1.26]。结论高血压并冠心病患者RDW水平比单纯高血压患者明显增高。冠心病除了与传统的年龄、性别及吸烟有关外,还与RDW明显相关。EH和冠心病患者左心室收缩功能正常时,RDW与LAD、LVEDd、LVEF及LVMI无关。
Objective To investigate the changes of erythrocyte distribution width (RDW) in patients with hypertension and coronary heart disease (CHD) and the relationship between RDW and cardiac structure and function. Methods 305 hypertensive patients were selected. Patients were divided into two groups according to coronary angiography: hypertension and coronary heart disease (EH + coronary heart disease) and essential hypertension (EH). The two groups of related clinical data, echocardiography and coronary heart disease as the influencing factors were analyzed and compared. Results Compared with the same sex, RDW in EH + CHD group was significantly higher than that in EH group [male: (13.77 ± 0.91)% vs (13.44 ± 0.73)%; female: (13.74 ± 0.67)% vs (13.44 ± 0.74)% ; All P <0.01]. The left atrium diameter (LAD) and left ventricular diastolic dimension (LVEDd) in patients with EH + coronary heart disease were significantly higher than those in patients with EH (all P <0.01), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF) EH patients (P <0.05, P <0.01). There was no significant difference between the two groups in IVS and LVMI (P> 0.05). Pearson correlation analysis showed that there was no correlation between RDW and left ventricular structure and function. Logistic regression analysis showed that the risk of coronary heart disease was significantly related to age, sex, smoking and RDW [OR = 1.05 (every 10 years), 0.42 (women), 2.00 and 1.26 respectively]. Conclusion The level of RDW in patients with hypertension and coronary heart disease is significantly higher than that in patients with hypertension alone. Coronary heart disease in addition to the traditional age, gender and smoking related, but also with RDW significantly related. When left ventricular systolic function is normal in patients with EH and coronary heart disease, RDW is independent of LAD, LVEDd, LVEF and LVMI.