2019 年第 10 期 第 14 卷

老年H型高血压患者红细胞分布宽度与早期肾损伤的相关性研究

Relation between red blood cell distribution width and early renal injury in elderly patients with H-type hypertension

作者：姜惠敏黄立纲田敬华杨金玲黄山尚菊菊洪燕英    

英文作者：

单位：100010首都医科大学附属北京中医医院检验科（姜惠敏、田敬华、杨金玲、黄山、洪燕英），心内科（尚菊菊）；100016北京，清华大学第一附属医院检验科（黄立纲）

英文单位：

关键词：H型高血压；红细胞分布宽度；肾功能损伤

英文关键词：

• 摘要：

• 【摘要】目的    探讨老年H型高血压患者红细胞分布宽度（RDW）与早期肾损伤的关系及其预测价值。方法    选取2014年11月至2018年11月首都医科大学附属北京中医医院和清华大学第一附属医院收治的老年原发性高血压患者312例作为研究对象，血清同型半胱氨酸（Hcy）＞10 μmol/L的H型高血压患者（202例）为观察组，血清Hcy＜10 μmol/L的单纯高血压患者（110例）为对照组。比较2组患者RDW、血清Hcy、尿微量白蛋白/肌肝比值（UACR）、血清肌酐、血清β2微球蛋白(β2-MG)、血清胱抑素C及估算肾小球滤过率(eGFR)。分析RDW与肾功能指标的相关性；分析早期肾损伤的危险因素；通过受试者工作特征（ROC）曲线分析各指标联合检测对早期肾损伤的诊断价值。结果    观察组血清Hcy水平、RDW、UACR、血清β2-MG、血清胱抑素C水平均明显高于对照组［（24.1±4.1）μmol/L比（7.9±2.9）μmol/L、（18.0±2.1）%比（14.2±2.1）%、（97±13）mg/g比（85±18）mg/g、（9.0±0.3）mg/L比（6.4±0.6）mg/L、（1.22±0.20）mg/L比（0.86±0.11）mg/L］，差异均有统计学意义(均P＜0.05)。2组血清肌酐水平和eGFR之间差异无统计学意义（P＞0.05）。观察组早期肾损伤发生率明显高于对照组［55.4%（112/202）比40.0%（44/110）］，差异有统计学意义（P＝0.01）。Pearson相关分析结果显示，RDW与UACR、血清β2-MG和胱抑素C水平均呈明显正相关（r＝0.34、0.22、0.17；P＜0.01、＜0.01、=0.02）。多因素Logistic回归分析显示，RDW、UACR、血清β2-MG、胱抑素C、Hcy均为老年H型高血压患者发生早期肾损伤的独立危险因素（均P＜0.05）。ROC曲线分析结果显示，RDW联合UACR＋β2-MG＋胱抑素C诊断早期肾损伤的价值较UACR＋β2-MG＋胱抑素C更高（曲线下面积0.759比0.668，P＜0.05）。结论    RDW是老年H型高血压患者早期肾损伤独立预测指标之一，联合检测RDW及早期肾损伤指标可以提高预测价值。

• 【Abstract】Objective    To explore the relation between red blood cell distribution width（RDW） and early renal injury in elderly patients with H-type hypertension; to analyze the value of RDW predicting renal injury. Methods    A total of 312 elderly patients with essential hypertension admitted to Beijing Hospital of Traditional Chinese Medicine, Capital Medical University and the First Hospital of Tsinghua University from November 2014 to November 2018 were enrolled. According to the level of serum homocysteine（Hcy）, the patients were divided into H-type hypertension group（202 cases, Hcy＞10 μmol/L） and simple hypertension group（110 cases, Hcy＜10 μmol/L）. RDW, serum Hcy, urinary microalbumin to creatinine ratio (UACR), serum creatinine, serum β2-microglobulin(β2-MG), serum cystatin C (CysC) and estimated glomerular filtration rate(eGFR) were detected. Relation between RDW and renal function indicators and risk factors of early renal injury were analyzed. Diagnostic values of combined indexes for early renal injury were analyzed by receiver operating characteristic(ROC) curve. Results    Levels of serum Hcy, RDW, UACR, serum β2-MG and serum CysC in observation group were significantly higher than those in control group［（24.1±4.1）μmol/L vs （7.9±2.9）μmol/L, （18.0±2.1）% vs （14.2±2.1）%, （97±13）mg/g vs （85±18）mg/g, （9.0±0.3）mg/L vs （6.4±0.6）mg/L, （1.22±0.20）mg/L vs （0.86±0.11）mg/L］(all P＜0.05). Levels of serum creatinine and eGFR showed no significant differences between groups(P＞0.05). Incidence of early renal injury in observation group was significantly higher than that in control group［55.4%（112/202） vs 40.0%（44/110）］（P＝0.01）. Pearson analysis showed that RDW was positively correlated with UACR, serum β2-MG and CysC（r＝0.34, 0.22, 0.17; P＜0.01, ＜0.01, =0.02）. Multivariate logistic regression showed that RDW, UACR, serum β2-MG, CysC and Hcy were independent risk factors of early renal injury（all P＜0.05）. ROC curve indicated that the predictive value of RDW combined with UACR＋β2-MG＋CysC was higher than that of UACR＋β2-MG＋CysC(area under curve: 0.759 vs 0.668, P＜0.05). Conclusion    RDW is an independent predictor for early renal injury in elderly patients with H-type hypertension; joint detection of RDW with renal function indicators can improve the predictive value.