血清GGT、RDW水平评估肺源性心脏病心力衰竭患者预后的价值

Value of Serum GGT and RDW Levels in Evaluating Prognosis of Patients with Heart Failure Due to Pulmonary Heart Disease

摘要: 目的：探讨血清γ-谷氨酰转移酶(GGT)、红细胞分布宽度(RDW)水平在评估肺源性心脏病心力衰竭患者预后中的价值，为临床预后判断提供依据。方法：回顾性分析672例肺源性心脏病心力衰竭患者，根据预后分为预后良好组(606例)和预后较差组(66例)。比较两组患者血清GGT、RDW水平，同时分析心肺功能指标(NT-proBNP、LVEF、PASP等)及炎症指标差异。采用单因素logistic回归筛选有统计学意义的变量，将年龄、NT-proBNP、LVEF、hs-CRP、PaO₂与GGT、RDW一同纳入多变量logistic回归分析独立危险因素，ROC曲线评估预测效能。结果：预后较差组血清GGT水平为(106.61 ± 3.96) U/L，显著高于预后良好组的(89.14 ± 1.53) U/L (P < 0.001)；RDW水平为(18.33 ± 1.49)%，低于预后良好组的(21.38 ± 2.25)% (P < 0.001)。预后较差组NT-proBNP升高(850.36 ± 152.84 pg/mL vs 580.25 ± 105.32 pg/mL, P < 0.001)，LVEF降低(42.53 ± 7.15% vs 55.84 ± 6.21%, P < 0.001)，炎症指标(hs-CRP、IL-6等)均显著异常。多变量logistic回归显示，GGT (OR = 1.876, 95% CI 1.412~2.493, P < 0.001)和RDW (OR = 1.732, 95% CI 1.345~2.231, P < 0.001)仍是不良预后独立危险因素(校正年龄、NT-proBNP、LVEF、hs-CRP、PaO₂后)。ROC曲线显示，GGT联合RDW检测的AUC为0.885，敏感性82.35%，特异性85.27%。结论：血清GGT、RDW水平与肺源性心脏病心力衰竭患者预后密切相关，联合检测可有效预测不良心血管事件风险，为临床预后评估提供参考。

Abstract: Objective: To explore the value of serum gamma-glutamyl transferase (GGT) and red blood cell distribution width (RDW) levels in evaluating the prognosis of patients with heart failure due to pulmonary heart disease, and to provide a basis for clinical prognosis judgment. Methods: A retrospective analysis was performed on 672 patients with heart failure due to pulmonary heart disease, who were divided into a good prognosis group (606 cases) and a poor prognosis group (66 cases) according to their prognosis. Serum GGT and RDW levels were compared between the two groups, and differences in cardiopulmonary function indicators (NT-proBNP, LVEF, PASP, etc.) and inflammatory indicators were analyzed. Univariate logistic regression was used to screen statistically significant variables, and age, NT-proBNP, LVEF, hs-CRP, and PaO₂ were included in the multivariate logistic regression model together with GGT and RDW to analyze independent risk factors. The ROC curve was used to evaluate the predictive efficiency. Results: The serum GGT level in the poor prognosis group was (106.61 ± 3.96) U/L, significantly higher than (89.14 ± 1.53) U/L in the good prognosis group (P < 0.001); the RDW level was (18.33 ± 1.49)%, lower than (21.38 ± 2.25)% in the good prognosis group (P < 0.001). In addition, NT-proBNP was elevated (850.36 ± 152.84 pg/mL vs 580.25 ± 105.32 pg/mL, P < 0.001), LVEF was decreased (42.53 ± 7.15% vs 55.84 ± 6.21%, P < 0.001), and inflammatory indicators (hs-CRP, IL-6, etc.) were significantly abnormal in the poor prognosis group. Multivariate logistic regression showed that GGT (OR = 1.876, 95% CI 1.412~2.493, P < 0.001) and RDW (OR = 1.732, 95% CI 1.345~2.231, P < 0.001) remained independent risk factors for poor prognosis (after adjusting for age, NT-proBNP, LVEF, hs-CRP, PaO₂). The ROC curve showed that the combined detection of GGT and RDW had an AUC of 0.885, with a sensitivity of 82.35% and a specificity of 85.27%. Conclusion: Serum GGT and RDW levels are closely related to the prognosis of patients with heart failure due to pulmonary heart disease. Combined detection can effectively predict the risk of adverse cardiovascular events, providing a reference for clinical prognosis evaluation.