红细胞体积分布宽度与非体外循环冠状动脉旁路移植术患者远期死亡关系的研究

Association Between Red Blood Cell Distribution Width and Long-term Mortality After Off-pump Coronary Artery Bypass Surgery

目的:探讨红细胞体积分布宽度(RDW)对非体外循环冠状动脉旁路移植术(OPCAB)患者远期死亡的预测价值。方法:共纳入中国医学科学院阜外医院2009年10月到2012年9月期间由单一术者施行单纯OPCAB的440例患者。收集患者入院时RDW及其他临床基线资料,术后通过电话或门诊进行远期随访。主要临床终点事件为全因死亡,并就此分为死亡组和生存组进一步分析。结果:在平均随访(7.0±1.1)年期间,死亡40例,死亡率为9.1%(40/440)。死亡组(n=40)患者入院时的RDW值显著高于生存组(n=400)患者[(13.2±0.7)%vs(.12.8±0.7)%,P=0.001]。采用Cox比例风险回归模型进行分析,带入不同模型的分析结果显示,入院时RDW值每升高1%,OPCAB患者术后远期死亡风险显著增加(HR值分别为1.862、1.841和2.019,P分别<0.001、0.003和0.008)。ROC曲线分析显示,预测远期死亡的RDW截断值为13.4%。Kaplan-Meier生存曲线分析显示,RDW值≥13.4%的患者(n=90)较RDW值<13.4%(n=350)的患者远期生存率更低(82.2%vs.93.1%,P=0.001)。结论:RDW是OPCAB患者远期死亡的独立危险因素,当RDW值≥13.4%时,患者远期死亡风险显著增加。

Objectives:The association between red blood cell distribution width(RDW)and long-term mortality in patients undergoing off-pump coronary artery bypass(OPCAB)surgery remains elusive.Relationship between RDW on admission and the risk of mortality in patients undergoing OPCAB was explored in this study.Methods:We retrospectively analyzed the data of 440 consecutive,non-anemic patients,who underwent OPCAB between October 2009 and September 2012 in our hospital.Long-term follow-up was obtained through phone calls,hospital records and clinical visits.Results:Over a mean of(7.0±1.1)years follow-up,a total of 40 patients died(mortality rate was 9.1%).The RDW levels on admission were significantly higher in non-survival group than in survival group([13.2±0.7]%vs.[12.8±0.7]%,P=0.001).Using the Cox proportional hazards models,we found that per 1%increment of RDW,the incident of death was increased in different models(Hazard Ratio was 1.862,1.841,2.019 respectively,P<0.001,0.003,0.008 respectively).The ROC analyze revealed a RDW cut-off value of 13.4%could fairly predict long-term mortality.The Kaplan-Meier plot revealed significantly lower event-free survival in the RDW≥13.4%group than in RDW<13.4%group(82.2%vs.93.1%,P=0.001).Conclusions:A RDW level greater than 13.4%at hospital admission is independently associated with an increased incidence of long-term mortality after OPCAB.