内科危重患者的红细胞分布宽度与预后及危重程度的相关性研究

Relationship of red cell distribution width with the prognosis and severity of critical illness among medical patients

目的探讨内科危重患者的红细胞分布宽度（RDW）水平与预后、急性生理学及慢性健康状况评分Ⅱ（APACHEⅡ）的关系。方法选择2011—02—2012—01收住急诊ICU的104例内科患者，在入ICU第一个24h内抽取静脉血检测血常规（包括RDW）。根据入ICU后24h内的APACHEⅡ评分分为APACHEⅡ评分〈20分组和APACHEⅡ≥20分组，比较两组RDW水平和死亡率；根据RDW水平分为RDW〈11．55％组和RDW≥11．55％组，比较两组APACHEⅡ评分和死亡率；根据l临床转归分为存活组和死亡组，比较两组APACHEⅡ评分和RDW水平，并对RDW水平及APACHEⅡ评分进行相关性分析。结果不同APACHEⅡ评分组随着APACHE11评分的升高，RDW水平亦增高，死亡率增加，两组RDW水平和死亡率比较差异有统计学意义（P〈0．01）；不同RDW水平组随着RDW水平的升高，APACHEⅡ评分和死亡率亦随之增高，两组比较差异有统计学意义（P〈0．01）；存活组和死亡组APACHEⅡ评分、RDW水平比较差异均有统计学意义（P〈0．01）；RDW水平与APACHEⅡ评分呈正相关（rs=0．315，P〈0．01）。结论在内科危重患者中，RDW水平与APACHEⅡ评分具有相关性，可能适用于内科患者的危重程度评估和预后估测。

Objective To investigate the relationship of red cell distribution width （RDW） with acute physiology and chronic health evaluation II （ APACHE II ） and prognosis in critical illness among medical patients. Methods From February 2011 to January 2012, 104 medical patients in our ICU were enrolled in the study. Blood samples were taken within 24 h after admission to ICU for blood routine test （including RDW）. The RDW level and mortality were compared between two groups（ APACHE H score 〈20 and APACHE II score≥20） according to the level of APACHE II within 24 h. The differences in APACHE IT score and mortality were compared between two groups （RDW 〈 11.55% and RDW≥ 11.55% ）. Differences in APACHE II score and RDW level were compared in survival group and death group based on their hospital outcomes. The correlation between RDW level and APACHE II score were analyzed by Spearman correlation test. Results With the increase of APACHE II score, RDW level and mortality were raised （P 〈 0. 01 ）. APACHE II score and mortality were increased with the rise of RDW level （ P 〈 0.01 ）. Both RDW level and APACHE lI score were significantly higher in death group than in survival group （ both P 〈 0. 001 ）. RDW was significantly correlated with APACHE II score （ rs= 0.315, P 〈 0.01 ）. Conclusion RDW level correlates well with APACHE II score in critically ill medical patients. RDW level may be appropriate for the evaluation of the severity of critical illness, as well as prognosis estimation in medical patients.