红细胞分布宽度在肺血栓栓塞症早期死亡风险分层中的价值研究

Clinical significance of red cell distribution width in the early mortality risk of pulmonary thromboembolism

目的研究红细胞分布宽度(RDW)在肺血栓栓塞症早期死亡风险分层中的应用价值。方法收集2013年12月至2016年12月大连医科大学附属第一医院确诊肺血栓栓塞症(PTE)的住院患者99例。依据2014年欧洲心脏病学会(ESC)急性肺血栓栓塞症诊疗指南分为低危组(44例)、中低危组(38例)、中高危组(10例)、高危组(7例)4组。分析4组间RDW的差异及相关性。分析99例PTE患者RDW与脑利钠尿肽(BNP)、肌钙蛋白I(cTnI)、D-二聚体是否具有相关性。结果单因素方差分析发现,4组患者RDW差异有统计学意义(P<0.001)。从低危组到高危组,随着早期风险分层逐渐升高,RDW均值逐渐升高。Spearman相关分析显示,RDW与早期死亡风险分层呈显著正相关(r=0.558,P<0.001)。Fisher精确检验分析发现,4组间RDW升高率(RDW>14.6%)的差异有统计学意义(P<0.001)。Spearman相关分析显示,RDW与BNP(r=0.440,P<0.001)、cTnI(r=0.275,P=0.006)显著正相关,与D-二聚体没有相关性(r=0.002,P=0.981)。结论 RDW的升高(RDW>14.6%)与肺血栓栓塞症早期死亡风险分层相关,对PTE患者病情严重程度的评估有一定的指导意义。

Objective To analyze the value of red cell distribution width(RDW)in the early mortality risk of pulmonary thromboembolism.Methods We collected 99 cases confirmed pulmonary thromboembolism from September 2011 to March 2014 in the First Affiliated Hospital of Dalian Medical University.The patients were divided into four groups according to the mortality risk:low-risk group,mediate-low-risk group,mediate-high-risk group and high-risk group.We analyzed the difference of RDW between the four groups and the correlation between RDW and brain natriuretic peptide(BNP),troponin I(cTnI)and D-dimer level.Results There were no significant difference in age,gender,hemoglobin,fibrinogen,low density lipoprotein,smoking history,tumor history,diabetes history,hypertension history and coronary heart disease among the four groups(P>0.05).RDW was significantly different among the four groups(P<0.001).The average value of RDW increased with the rise of early mortality risk(r=0.558,P<0.001).RDW was positively correlated with BNP(r=0.44,P<0.001),cTnI(r=0.275,P=0.006),but not with D-dimer(r=0.002,P=0.981).Conclusion The increase of RDW(RDW>14.6%)would be used to evaluate the severity of PTE.