输血后红细胞分布宽度和脂蛋白相关磷脂酶A2对冠心病诊断价值的影响

Changes of RDW and Lp-PLA2 Levels in the Influence of the Diagnostic Value on the Coronary Heart Disease After Blood Transfusion

目的探讨输血后红细胞分布宽度(RDW)和脂蛋白相关磷脂酶A2(Lp-PLA2)对冠心病(CHD)诊断价值的影响。方法收集2014年5月—2017年5月间在南方医科大学附属新会医院心血管内科治疗的冠心病贫血患者共68例,按前后输注1U^2U悬浮红细胞分为输血前患病组和输血后患病组,另选择68名健康体检者为正常对照组。用五分类血细胞分析仪检测各组血常规获得RDW结果,用ELISA(双抗体夹心酶联免疫法)检测各组的Lp-PLA2水平。结果输血前和输血后两组患者的RDW水平均高于对照组(P<0.05),Lp-PLA2水平均高于对照组(P<0.05,P<0.01)。输血前后两组患者的HGB水平明显低于对照组(P<0.01),而WBC、TG、TC、LDL-C、Lpa的水平明显高于对照组(P<0.05)。用相关性分析显示,输血前后两组RDW和Lp-PLA2水平之间没有相关性(r分别为0.054、0.068,P>0.05)。用ROC曲线分析输血前RDW联合Lp-PLA2对CHD诊断的灵敏度为70.6%,特异性为61.1%,AUC(曲线下面积)为0.658;输血后的灵敏度为78.4%,特异性为54.7%,AUC为0.670。结论输血前后RDW和Lp-PLA2均可作为CHD发生的风险预测指标,输血后两者联合检测能提高对CHD诊断的灵敏性,但特异性降低,此时可用特异性更高的方法来诊断。

Objective To investigate the changes of RDW and Lp-PLA2 levels in the influence of the diagnostic value on the coronary heart disease after blood transfusion. Methods Sixty-eight anemia patients with CHD in the cardiology department of our hospital from May, 2014 to May, 2017 were collected and divided into the before transfusion group and post transfusion group accord- ing to infuse 1 ~ 2U red blood cells suspension before and after blood transfusion. Another Sixty-eight heahhy people were chosen as the healthy control group. The RDW levels was detected by five-classification fully automatic hematology analyze and the Lp-PLA2 levels was detected by double-antibody sandwich enzyme-linked immunosorbent assay. Results RDW levels significantly increased in the before transfusion group and post transfusion group, compared with the healthy control group（P 〈 0. 05 ）. The Lp-PLA2 levels in the before transfusion group and post transfusion group increased significantly compared with the healthy control group（P 〈 0. 05, P 〈0. 01 ）. HGB level of before and post transfusion group was significantly lower than the control group（P 〈0. 05）, but WBC, TG, TC, LDL-C, Lpa levels of before and post transfusion group were significantly higher than control group （P 〈 0. 05 ）. There was no correlation between RDW and Lp-PLA2 in the before transfusion group and post transfusion group by the correlation analysis （R = 0. 054, 0. 068, P 〉0.05）. By the combination detection of RDW and Lp-PLA2, the ROC curve analysis in the diagnostic on the coronary heart disease showed that in the before transfusion group, the sensitivity was 70. 6% and the specificity was 61.1%. The ar- eas under ROC curve was 0. 658. In the post transfusion group, the sensitivity was 78.4% and the specificity was 54. 7%. The areas under ROC curve was 0. 670. Conclusion The RDW and Lp-PLA2 can be the predictive factors in the mechanism of the coronary heart disease before and after blood transfusion. By the combination detection of RDW and Lp-PLA2 after blood transfusion, it can improve the diagnostic sensitivity, but the specificity would be reduced. Much more specificity methods should be used to detect in the diagnostic on the coronary heart disease.