Abstract: Objective　To investigate the relationship between red blood cell distribution width (RDW) and left ventricular diastolic dysfunction (LVDD) in patients with chronic kidney diseases (CKD), and to evaluate the predictive value of RDW for LVDD in CKD patients. Methods　Adult CKD patients who were hospitalized and underwent echocardiography in The First Affiliated Hospital of Guangdong Pharmaceutical University from January 2015 to February 2020 were selected, including 83 males and 49 females. The general data, medical history, blood routine, biochemical indexes, and echocardiographic indexes were recorded. The general data and clinical indicators were compared between the normal left ventricular diastolic function group and the LVDD group. Independent sample t test was used for inter-group comparison of the measurement data with normal distribution, non-parametric rank sum test was used for inter-group comparison of the measurement data with abnormal distribution, Chi-square test was used for inter-group comparison of the count data, Spearman rank correlation was used for correlation analysis, and binary logistic regression analysis was used for risk factor analysis of LVDD. Receiver operating characteristic curve (ROC) and area under curve (AUC) were used to evaluate the predictive value of RDW for LVDD. Results　There were 59 cases in the normal left ventricular diastolic function group and 73 cases in the LVDD group. The systolic blood pressure and RDW of the LVDD group were higher than those of the other group (both P<0.05); the proportion of coronary heart disease in the LVDD group was higher than that in the other group (P=0.037); left ventricular mass index (LVMI) and early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio (E/e') of the LVDD group were significantly higher than those of the other group, and e' was lower than that of the other group (all P<0.05). Univariate correlation analysis showed that RDW was positively correlated with E/e', interventricular septal thickness (IVST), phosphorus (P), calcium-phosphorus product (Ca×P), cystatin C (CysC), and brain natriuretic peptide (BNP) (all P<0.05), and negatively correlated with estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) (both P<0.05). E/e' was positively correlated with left ventricular end-diastolic dimension (LVDd), LVMI, end-systolic volume (ESV), end-diastolic volume (EDV), ratio of early to late diastolic peak velocity of mitral flow (E/A), P, Ca×P, CysC, and RDW (all P<0.05), and negatively correlated with e', eGFR, Hb, total cholesterol (TC), and low density lipoprotein (LDL) (all P<0.05). Multivariate logistic regression analysis showed that RDW was a risk factor of LVDD (OR>1), and Hb was a protective factor of LVDD (OR<1). ROC analysis showed that the AUC of LVDD predicted by RDW was 0.612, the sensitivity was 78.9%, and the specificity was 50.8%. Conclusions　LVDD is more likely to occur in CKD patients. Detection of RDW is of certain value in predicting LVDD in CKD patients.

Key words: Chronic kidney diseases, Left ventricular diastolic dysfunction, Red blood cell distribution width

摘要： 目的　探讨慢性肾脏病（CKD）患者红细胞分布宽度（RDW）与左心室舒张功能不全（LVDD）的关系，评估RDW对于CKD患者LVDD的预测价值。方法　选取2015年1月至2020年2月在广东药科大学附属第一医院住院并行超声心动图的成年CKD患者，男83例、女49例。记录患者的一般资料、病史、血常规及生化指标、心脏超声指标。对左心室舒张功能正常组及LVDD组的临床资料进行比较，呈正态分布的计量资料组间比较采用独立样本t检验，非正态分布的计量资料组间比较采用非参数秩和检验，计数资料组间比较使用卡方检验，采用Spearman秩相关进行相关性分析，LVDD的危险因素分析采用二分类logistic回归分析，利用受试者工作特征曲线（ROC）和曲线下面积（AUC）评估RDW对LVDD的预测价值。结果　左心室舒张功能正常组有59例，LVDD组有73例。LVDD组的收缩压、RDW较左心室舒张功能正常组高（均P<0.05）；LVDD组中冠心病的比例较左心室舒张功能正常组高（P=0.037）；LVDD组的左心室心肌重量指数（LVMI）、二尖瓣血流舒张早期与瓣环运动峰值速度比值（E/e'）明显高于左心室舒张功能正常组，LVDD组的二尖瓣环舒张早期运动速度（e'）低于左心室舒张功能正常组（均P<0.05）。单因素相关分析示RDW与E/e'、室间隔厚度（IVST）、磷（P）、钙磷乘积（Ca×P）、胱抑素C（CysC）、脑钠肽（BNP）呈正相关（均P<0.05），RDW与估算肾小球滤过率（eGFR）、血红蛋白（Hb）呈负相关（均P<0.05）；E/e'与左心室舒张末期内径（LVDd）、LVMI、收缩末期容积（ESV）、舒张末期容积（EDV）、二尖瓣血流的舒张早期和晚期速度峰值比值（E/A）、P、Ca×P、CysC、RDW呈正相关（均P<0.05），E/e'与e'、eGFR、Hb、总胆固醇（TC）、低密度脂蛋白（LDL）呈负相关（均P<0.05）。多因素logistic回归分析显示RDW是LVDD的危险因素（OR>1），Hb是LVDD的保护因素（OR<1）。ROC分析显示RDW预测LVDD的AUC为0.612，灵敏度78.9%，特异度50.8%。结论　CKD患者较容易发生LVDD，检测RDW对预测CKD患者并发LVDD存在一定的价值。

关键词: 慢性肾脏病, 左心室舒张功能不全, 红细胞分布宽度