外周血红细胞宽度检测在食管癌患者临床诊断中的应用价值

Value of Peripheral Red Blood Cell Distribution Width in Clinical Diagnosis of Esophageal Cancer

目的:探讨外周血红细胞宽度(red blood cell distribution width,RDW)检测在食管癌患者临床诊断及病情评估中的应用价值。方法:回顾性收集2017年1月至12月在四川省肿瘤医院行根治性切除术的250例食管癌患者的临床病理及血常规检查资料,以同期我院健康体检的250例健康人群作为对照;绘制ROC曲线并寻找RDW诊断食管癌的最佳截断值,依据截断值将食管癌患者分为高RDW和低RDW两组,采用多因素Logistic回归模型筛选食管癌患者RDW增高有关临床病理因素。结果:食管癌患者的红细胞、血红蛋白、淋巴细胞平均水平明显低于健康对照组;而中性粒细胞水平高于对照人群(均P<0.05)。病例组食管癌患者的外周血RDW中位水平明显高于健康对照组[12.8(12.6~13.0)vs 12.4(12.2~12.6)],差异有统计学意义(Z=-15.330,P<0.001)。年龄>60岁、肿瘤分期为Ⅲ~Ⅳ期、有远处转移与RDW的升高存在显著的正相关关系(均P<0.05),具体表现为:年龄>60岁食管癌患者RDW升高的风险是≤60岁患者的2.989倍,Ⅲ-Ⅳ期食管癌患者RDW升高的风险是Ⅰ-Ⅱ期患者的3.861倍,有发生远处转移的食管癌患者RDW升高的风险是未发生远处转移患者的6.013倍。结论:RDW值测量作为一种快速、简单、经济且易获得的一项生物学指标,可以作为一个食管癌临床诊断及预测食管癌病情严重程度的一项参考指标。

Objective: To evaluate the value of peripheral red blood cell distribution width ( RDW) in clinical diagnosis of esophageal cancer. Methods: Clinical and blood routine examination data of 250 patients with esophageal cancer undergoing radical resection during January 2017 to December 2017 in Sichuan Cancer Hospital were retrospectively analyzed, and another 250 healthy volunteers were collected at the same time as control group for comparative analysis. We drew the ROC curve and found the best truncation value of RDW in the diagnosis of esophageal cancer. The esophageal cancer patients were divided into two groups, high and low RDW group, according to RDW cut-off value based on ROC curve. Results: The mean levels of erythrocyte, hemoglobin and lymphocyte in esophageal cancer patients was significantly lower than those in control group (P <0. 05), while the level of neutrophils in esophageal cancer patients was higher than that in control subjects (P <0.05). The median level of RDW in patients with esophageal cancer was significantly higher than that in control group ([ 12. 8 (12.6- 13. 0) vs 12.4 (12.2-12.6), Z=- 15.330, P<0.001]. More than 60 years old,Ⅲ~Ⅳ stage in tumor staging and distant metastasis were positively correlated with the increase of RDW ( P < 0. 05 ). In specific, the risk of increased RDW in esophageal cancer patients over 60 was 2. 989 times greater than in those not more than 60;that in Ⅲ~Ⅳ stage esophageal cancer patients was 3. 861 times greater than inⅠ~Ⅱ stage esophageal cancer patients;and that was 6. 013 times greater in esophageal cancer patients with distant metastasis compared with those without distant metastasis. Conclusion: As a fast, simple, economical and easily obtained biological index, RDW value can be used as an index for the clinical diagnosis and prediction of the severity of esophageal cancer.