Kataoka Hajime
a Internal Medicine , Nishida Hospital , Oita , Japan.
Scand J Clin Lab Invest. 2018 Jul;78(4):305-311. doi: 10.1080/00365513.2018.1466607. Epub 2018 Apr 27.
This study examined how changes in heart failure (HF) status induce changes in the index of erythrocyte hydration based on mean red blood cell volume (MCV). Data from 47 HF patients (32% men; 78.2 ± 9.7 years) that experienced worsening and recovery of HF were analysed. Blood tests included measurements of MCV, albumin, serum solutes and b-type natriuretic peptide (BNP). Among a total of 47 worsening HF events, changes in MCV were positively correlated with changes in body weight (r = 0.31, p = .034), serum sodium (r = 0.417, p = .0036), and chloride (r = 0.457, p = .0012), and negatively correlated with changes in blood urea nitrogen (r= -0.389, p = .0069) and creatinine (r= -0.494, p = .0004). At recovery from worsening of HF by conventional diuretic therapy, change in MCV was positively correlated with the change in body weight (r = 0.457, p = .0012), serum sodium (r = 0.466, p = .001) and chloride (r = 0.484, p = .0006). Multivariate regression analysis demonstrated an independent association between the increase in serum chloride and MCV from stability to worsening of HF (odds ratio [OR] 6.02, 95% confidence interval [CI] 1.09-33.2, p = .039) and the increase or absence of change in serum chloride concentration and preserved MCV after decongestion (OR 11.5, 95% CI 1.53-85.9, p = .017). In conclusion, this study demonstrates that the changes in MCV under transition in HF status do not reflect a change that occurs in parallel with changes in HF-related markers, such as body weight and serum BNP level, but is independently associated with a change in the serum chloride concentration. Whether changes in MCV actually reflect the bodily cellular hydration status warrants further research.
本研究基于平均红细胞体积（MCV），探讨了心力衰竭（HF）状态变化如何引起红细胞水合指数的变化。分析了47例经历HF恶化和恢复的HF患者（32%为男性；年龄78.2±9.7岁）的数据。血液检测包括MCV、白蛋白、血清溶质和b型利钠肽（BNP）的测量。在总共47次HF恶化事件中，MCV的变化与体重变化（r = 0.31，p = 0.034）、血清钠（r = 0.417，p = 0.0036）和氯（r = 0.457，p = 0.0012）呈正相关，与血尿素氮变化（r = -0.389，p = 0.0069）和肌酐变化（r = -0.494，p = 0.0004）呈负相关。在通过传统利尿治疗使HF恶化得到恢复时，MCV的变化与体重变化（r = 0.457，p = 0.0012）、血清钠（r = 0.466，p = 0.001）和氯（r = 0.484，p = 0.0006）呈正相关。多因素回归分析表明，从HF稳定到恶化过程中血清氯升高与MCV之间存在独立关联（比值比[OR] 6.02，95%置信区间[CI] 1.09 - 33.2，p = 0.039），以及在充血消除后血清氯浓度升高或无变化且MCV保持不变之间存在独立关联（OR 11.5，95% CI 1.53 - 85.9，p = 0.017）。总之，本研究表明，HF状态转变时MCV的变化并不反映与体重和血清BNP水平等HF相关标志物变化同时发生的变化，而是与血清氯浓度变化独立相关。MCV的变化是否实际反映身体细胞水合状态值得进一步研究。
