红细胞分布宽度联合GRACE评分对急性冠脉综合征患者风险预测

Red blood cell distribution width combined GRACE risk score for predicting the risk of actcte coronary syndrome recent death

目的通过比较RDW在ACS患者中死亡组与非死亡组的水平,探讨RDW与GRACE评分相关性以及RDW联合GRACE评分在预测ACS近期死亡风险的意义,以提高临床预测的阳性率。方法选取2013年1月至2014年1月期间入住吉林大学中日联谊医院心血管内科的急性冠脉综合征患者412例,测定患者入院24h内RDW、RBC、Hb、WBC hs-CRP、GLU、SCr、TC、TG、LDL-C、γ-GGT、BNP的值;应用GRACE评分表对所有病人进行危险分层评分;通过在院观察、出院电话随访、病例查询方式记录患者30天内的主要心血管事件。研究RDW和GRACE评分对ACS患者30天死亡率的风险评估价值以及两者联合对死亡风险预测价值。结果 ACS患者中RDW水平≥13%近期预后较RDW水平<13%者的生存率降低;RDW曲线下面积(AUC)为0.750,GRACE评分曲线下面积(AUC)为0.757,二者联合为0.826;RDW水平与GRACE评分、WBC、hs-CRP、SCr、BNP、γ-GGT具有相关性,相关系数分别为0.406、0.563、0.522、0.483、0.713、0.457,P<0.05差异均有统计学意义。多因素线性回归显示RDW评分与WBC、hs-CRP、GRACE正相关,偏相关系数分别为0.396、0.452、0.518,P<0.05差异均有统计学意义。结论1.RDW与GRACE评分两者联合可以提高对ACS患者近期死亡风险的预测。2.RDW水平与GRACE风险评分呈正相关。3.RDW水平≥13%的ACS患者的近期死亡率较RDW水平<13%者高。4.RDW可以作为预测急性冠脉综合征30天内死亡风险的独立预测指标。

Objective This study compares the level of RDW death group and non-group death in ACS patients com- pared to a single combination of the two can evaluate the accuracy and sensitivity higher. Methods Select from January 2013 to January 2014 in our Hospital,According to the inclusion and exclusion criteria ,412 cases of patients with acute coronary syndrome were selected; Patients were measured within 24 hours of admission RDW, RBC, Hb, WBC hs- CRP, GLU, SCr, TC, TG, LDL-C 7-GGT ,BNP.. Application GRACE score sheet scoring record of major cardiovascu- lar events in patients within 30 days. Results RDW level of≥13% （mean of 13.09± 1.14） compared with short-term prognosis RDW levels 〈13% survival rate was significantly lower （Log rank 10. 897, P= 0. 001）, GRACE risk score 〈130 mean （130.15 ± 31.55） in the short-term prognosis of patients with ACS is better than GRACE≥130 receiver operating characteristic （Log rank 24. 423,P〈0. 001） 30 days deaths occurred curve （ROC）, RDW area under the curve （AUC） was 0. 757,RDW area under the curve （AUC） of 0. 750,0. 826 both joint,Univariate analysis by RDW levels and GRACE score,WBC, hs-CRP,SCr, BNP, γ-GGT has, the correlation coefficients were 0. 406,0. 563,0. 522, 0. 483,0.713,0.457, P〈0.05 differences were statistical significance, multivariate linear regression, the GRACE score, WBC, hs-CRP, still positively correlated with RDW, partial correlation coefficients were 0. 396,0. 452,0. 518, P〈 0.05 differences were statistically significant. Conclusion RDW and GRACE risk score combination can improve the predic- tion of mortality in patients with ACS. RDW levels correlated with the GRACE score. Level of RDW≥ 13 % compared with short-term prognosis RDW levels 〈13% death rate was significantly higher. RDW as predicting acute coronary syndrome independent predictor risk of death within 30 days.