红细胞分布宽度与脑梗死患者近期预后的相关性

Red cell distribution width and prognosis of cerebral infarction patients

摘要:

目的 探讨红细胞分布宽度（RDW）与脑梗死患者近期预后的相关性。方法 回顾性地分析159例首次诊断为脑梗死患者的临床资料，根据RDW中位数水平分为RDW低值组（n＝80）和RDW高值组（n＝79）。比较两组患者一般临床资料、实验室指标及死亡率的差异性。再根据临床转归分为两组，即存活组（n＝144）和死亡组（n＝15），比较其RDW水平及其他实验室指标的差异性。采用多重线性回归（逐步回归法）分析预后不良与各因素的相关性。建立RDW预测患者死亡的受试者工作特征（ROC）曲线，以约登指数法找到RDW预测死亡的最佳截断值。结果 RDW高值组的死亡率显著高于低值组（16.5% vs 2.5%，P＝0.003）。死亡组患者入院时的RDW水平显著高于存活组[（12.86±1.25）% vs （11.59±1.25）%，P＝0.000]。RDW水平与预后不良呈线性正相关（标准偏回归系数＝0.146，P＝0.032）。用RDW预判死亡，其ROC曲线下面积为0.782（95% CI 0.668?0.896），最佳截断值为12.35，准确度为78.6%。结论 入院时的RDW水平与脑梗死患者近期预后密切相关，对判断预后有重要参考价值。

Abstract:

Objective To investigate the correlation of red cell distribution width (RDW) with the prognosis of cerebral infarction patients, and to explore the prognostic value of RDW. Methods A total of 159 cases of cerebral infarction diagnosed at admission in our department from May 2011 to May 2012 were enrolled in this study. They were divided into 2 groups according to their RDW median levels: low-level RDW group (n＝80, RDW≤11.5%) and high-level RDW group (n＝79, RDW＞11.5%). The general clinical data, laboratory parameters, and mortality were compared between the 2 groups. And also, the patients were divided into survival group (n＝144) and death group (n＝15) based on their clinical outcomes. The RDW levels and mortality between the 2 groups were compared. The correlation between RDW and poor outcomes were analyzed by Spearman correlation test. Receiver operation characteristic (ROC) curve was used to determine the predictive value of RDW for hospital death. Results The mortality was significantly higher in the high-level RDW group than in the low-level RDW group (16.5% vs 2.5%, P＝0.003). The RDW level was significantly higher in death group than in the survival group [(12.86±1.25)% vs (11.59±1.25)%, P＝0.000]. Stepwise regression analysis indicated RDW had a positive correlation with poor outcome in the patients (standard partial regression coefficient＝0.146, P＝0.032). To predict hospital death, the area under ROC curve by RDW was 0.782 (95% CI 0.668?0.896). The best cut-off value determined by Yoden Index was 12.35 for RDW. The accuracy of prediction was 78.6%. Conclusion RDW level at admission in cerebral infarction patients is closely correlated with the short-term prognosis, and shows an important predictive value in the prognosis of the patients.