红细胞分布宽度对慢性阻塞性肺疾病短期预后的预测价值

Predictive value of red cell distribution width on short-term prognosis of chronic obstructive pulmonary disease

目的探讨红细胞分布宽度（RDW）对慢性阻塞性肺疾病（慢阻肺）短期预后的预测价值。方法连续纳入2012年10月至2013年7月于北京朝阳医院呼吸科住院的40岁以上因急性加重住院的慢阻肺患者543例,于病情缓解期收集基线数据。在其出院后进行6个月随访,终点事件为再次出现急性加重及死亡。通过统计学方法分析RDW对短期预后的评估价值。结果多因素Cox回归分析显示,RDW为急性加重期慢阻肺患者病情缓解出院后近期再次急性加重（HR=1.129,95%CI 1.038-1.228,P=0.005）或死亡（HR=1.303,95%CI 1.123-1.513,P=0.001）的独立危险因素。排除合并肺癌及缺血性心脏病的患者后,RDW仍是死亡的独立危险因素（HR=1.24,95%CI1.012-1.518,P=0.038）。经ROC曲线计算以RDW=13.6%为界值分组,生存分析显示RDW≤13.6%组预后显著优于RDW〉13.6%组。结论 RDW升高是急性加重期COPD患者病情缓解后短期不良预后的独立危险因素。

Objective To study the predictive value of red cell distribution width（RDW） on short-term prognosis of patients with chronic obstructive pulmonary disease（COPD）. Methods A total of 543 hospitalized patients due to acute exacerbation of COPD（AECOPD） were recruited in the study. Research data were collected during the remission period. Six months follow-up was started after discharged,and the endpoints were acute exacerbation and death. Statistical methods were used to evaluate the predictive value of RDW for the short-term prognosis. Results Multivariate cox regression analysis showed that RDW was an independent risk factor for acute exacerbation（HR = 1.129,95%CI 1.038-1.228,P = 0.005） or death（HR = 1.303,95%CI 1.123-1.513,P = 0.001） after the AECOPD patients were discharged. After exclusion of patients with lung cancer and ischemic heart disease,RDW was still the risk factor for death（HR = 1.24,95%CI 1.012-1.518,P = 0.038）. We calculated the cut-off value of RDW（13.6%） by receiver operating characteristic curve（ROC）. Kaplan-Meier analysis showed that the prognosis of the RDW ≤ 13.6% group was significantly better than the RDW〉 13.6% group. Conclusion High levels of RDW significantly correlate with poor prognosis of COPD. RDW is an independent risk factor for acute exacerbation and death.