红细胞分布宽度/白蛋白比值与慢性心力衰竭患病率和远期预后的关系:来自JDHS 2021-2022和NHANES 1999-2020的研究
Association of Red Blood Cell Distribution Width to Albumin Ratio with the Prevalence and Long Term Prognosis of Patients with Chronic Heart Failure:Studies From JDHS 2021-2022 and NHANES 1999-2020
周家顺 1刘春莉 1刘艳 1张林 2周兴悦1
作者信息
- 1. 天津市静海区医院,天津 301600
- 2. 天津中医药大学,天津 301617
- 折叠
摘要
目的 研究慢性心力衰竭(chronic heart failure,CHF)与红细胞分布宽度/白蛋白比(red blood cell distribution width to albumin ratio,RAR)的关系.方法 美国的国家健康与营养检查调查数据库(National Health and Nutrition Examination Survey Database,NHANES)提供了1999-2020间CHF的流行病学和随访数据,静海区医院(Jinghai District Hospital,JHDH)提供了2021-2022年的CHF流行病学数据.两个队列根据是否患有CHF,分为了CHF组和Con组.逐步特征消除被用来筛选协变量,广义线性模型被用来统计患病率的比值比(odds ratio,OR),使用4种模型观察CHF与RAR的关系.Cox回归模型对NHANES的CHF生存数据进行统计,分析RAR对CHF的远期预后价值.通过RAR的四分位分段(RARQ)观察RAR与CHF患病率之间的关系.限制性三次样条(restricted cubic spline,RCS)被用来寻找RAR预后的最佳分界值,Kaplan-Meier曲线用来分析RAR对CHF的远期预后.结果 NHANES队列包括Con组(n=58 687)和CHF组(n=2 067).JHDH队列包括Con组(n=12 760)和CHF(n=2 342).RARQ中Q1～Q4的CHF患病率在NHANES中是0.69%,1.52%,2.80%,6.00%;在JHDH中是4.75%,9.04%,17.42%,50.17%.Q4的CHF患病率是Q1的8.70倍(NHANES)和10.56倍(JHDH).两个队列RAR在Model4校正后的OR分别是2.27(95 CI%:1.5～3.42)和1.85(95 CI%:1.7～2.01).分析NHANES队列存活(n=784)和死亡(n=958)的CHF患者,校正后的RAR的危险比(HF)为2.28(95 CI%:1.55～3.36).RCS提示RAR对CHF远期预后的最佳分界值是3.4 dL/g.生存曲线显示高RAR组(>3.4 dL/g)的远期预后差于低RAR组(≤3.4 dL/g).RAR的预测价值远远高于传统的红细胞分布宽度(RDW).结论 RAR是CHF患病率和远期预后的危险因素.RAR对CHF的预测价值优于传统的红细胞分布宽度和血清白蛋白.RAR预测CHF远期预后的最佳分界值是3.4 dL/g.
Abstract
Objectives To study the relationship between red blood cell distribution width to albumin ratio(RAR)and chronic heart failure(CHF).Methods The National Health and Nutrition Examination Survey Database(NHANES)in the United States provided epidemiological and follow-up data on CHF from 1999 to 2020,and Jinghai District Hospital(JHDH)provided epidemiological data on CHF from 2021 to 2022.The two cohorts were divided into CHF group and Con group according to whether they had CHF or not.Stepped-feature elimination was used to screen covariates,generalized linear models were used to calculate odds ratios(OR)of prevalence,and 4 models were used to observe the relationship between CHF and RAR.Cox regression model was used to analyze the survival data of CHF in NHANES and the long-term prognostic value of RAR in CHF.The interquartile segment of RAR(RARQ)was used to observe the relationship between RAR and the prevalence of CHF.The restricted cubic spline(RCS)was used to find the best cut-off value of RAR prognosis,and Kaplan-Meier curve was used to analyze the long-term prognosis of RAR for CHF.Results The NHANES cohort consisted of Con(n=58 687)group and CHF group(n=2 067).The JHDH queue consists of Con group(n=12 760)and CHF group(n=2 342).The prevalence of CHF in Q1-Q4 in RARQ was 0.69%,1.52%,2.80%,6.00%in NHANES,and in JHDH,it was 4.75%,9.04%,17.42%,50.17%.The prevalence of CHF in Q4 was 8.70 times that of Q1(NHANES)and 10.56 times that of Q1(JHDH).The OR of the two cohort RAR after Model4 correction were 2.27(95 CI%:1.5-3.42)and 1.85(95 CI%:1.7-2.01),respectively.Analyzing the survival(n=784)and death(n=958)of CHF patients in the NHANES cohort,the adjusted hazard ratio(HF)for RAR was 2.28(95 CI%:1.55-3.36).RCS suggested that the best cut-off value of RAR for the long term prognosis of CHF was 3.4 dL/g.The survival curve showed that the long-term prognosis of the high RAR group(>3.4 dL/g)was worse than that of the low RAR group(≤3.4 dL/g).The predictive value of RAR is much higher than that of traditional red blood cell distribution width(RDW).Conclusions RAR is a risk factor for the prevalence and long term prognosis of CHF.The predictive value of RAR for CHF is better than that of traditional RDW and albumin.The best cut-off value of RAR for predicting the long term prognosis of CHF was 3.4 dL/g.
关键词
心力衰竭/红细胞分布宽度/白蛋白比值/远期预后/危险因素/多中心Key words
heart failure/red blood cell distribution width to albumin ratio/long term prognosis/risk factors/polycen-tric引用本文复制引用
出版年
2024
NETL
NSTL
万方数据