红细胞分布宽度与脑白质病变严重程度的相关性

The correlation between red blood cell distribution width and severity of brain white matter lesions

目的探讨红细胞分布宽度(RDW)与脑白质病变严重程度的相关性。方法收集头颅MRI证实脑白质病变患者,回顾性分析患者的临床资料及危险因素。结果 (1)本研究共纳入409例脑白质病变患者,根据Fezakas量表评分分成轻度者(n=266)和中重度者(n=143)。(2)单因素分析示:轻度与中重度者两组间比较年龄、高血压、红细胞计数、血红蛋白、RDW标准差(RDW-SD)、RDW变异系数(RDW-CV)、纤维蛋白原、肌酐、总胆固醇、同型半胱氨酸差异有统计学意义(P<0.05)。(3)多因素logistic回归分析示RDW-CV作连续型变量资料时,调整混杂因素后发现年龄(OR=1.158,95%CI 1.122~1.195,P<0.001)、高血压(OR=2.103,95%CI 1.254~3.526,P=0.005)、RDW-CV(OR=1.308,95%CI 1.062~1.610,P=0.011)是中重度脑白质病变的独立危险因素。(4)RDW-CV与中重度脑白质病变的受试者工作曲线,曲线下面积为0.643(95%CI 0.587~0.699,P<0.001),当约登指数最大时,RDW-CV最佳截断值为13.05%,其对中重度脑白质病变预测敏感度为51.0%,特异度为74.1%。结论在脑白质病变患者中,年龄、高血压、RDW-CV是中重度脑白质病变的独立危险因素,高水平RDW-CV对中重度脑白质病变有一定的预测价值。

Objective To investigate the correlation between red blood cell distribution width （RDW） and severity of brain white matter lesions （WML）. Methods A total of 409 patients with WML, were chosen for our study. The clinical data and risk factors were retrospectively analyzed. Results In this study, 409 patients with WML were divided into 2 groups, mild WML （n = 266） and moderate to severe WML （n = 143 ）. The resuhs of univariate analysis showed that age, hypertension, erythrocyte count, hemoglobin, red blood cell distribution width - standard deviation （ RDW - SD） , red blood cell distribution width - correlation variance （ RDW - CV） , fibrinogen, creatinine, total cholesterol and homocysteine were significantly different （P 〈 O. 05） between mild WML and moderate to severe WML patients. The results of multivariate logistic regression indicated that when RDW - CV acted as continuous variable data, age （ OR = 1. 158, 95% CI 1. 122 - 1. 195, P 〈 0. 001 ）, Hypertension （ OR = 2. 103, 95% CI 1. 254 - 3. 526, P = 0. 005）, and RDW - CV （ OR = 1. 308, 95% CI 1. 062 - 1. 610, P = 0. 011 ） were the independent risk factors for moderate to severe WML after adjusted confounding factors. The receiver operating characteristic curve （ROC） was constructed to determine the predictive value of RDW - CV for moderate to severe WML. The area under curve （AUC） was 0. 643 （95% CI O. 587 - 0. 699, P 〈0. 001 ）. The best cut- off value determined by Yoden Index was 13.05% for RDW- CV with the sensitivity of 51.0% and the specificity of 74. 1%. Conclusion Age, hypertension, and RDW - CV were the independent risk factors for moderate to severe WML in patients with WML. High RDW - CV provides a certain predictive value for moderate to severe WML.