红细胞体积分布宽度(RDW)在乙肝肝硬化中的临床意义

The clinical significance of red cell blood distribution width detection in patients with hepatitis B virus-related cirrhosis

目的探讨乙肝肝硬化患者全血红细胞体积分布宽度(RDW)的特点及临床意义。方法回顾性分析2018年1月至12月上海市第六人民医院感染科76例住院患者,其中包括31例乙肝肝硬化患者及45例慢性乙型肝炎(CHB)患者,观察患者RDW、血小板(PLT)、血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、白蛋白、前白蛋白水平、活化部分凝血活酶时间(APTT)和凝血酶原时间(PT)、HBeAg水平及HBVDNA载量。结果乙肝肝硬化组RDW水平显著高于CHB组(t=4.46,P<0.01)及健康对照组(t=8.01,P<0.01),CHB组RDW水平显著高于健康对照组(t=4.97,P<0.01);Child-Pugh评分为C的肝硬化组患者全血RDW水平显著高于评分为A和B的患者(t=7.28,P<0.01;t=2.29,P<0.05),Child-Pugh评分为B的患者血RDW水平显著高于评分为A的患者(t=3.10,P<0.01)。CHB组及乙肝肝硬化组RDW水平均与总胆红素水平呈正相关(r=0.45,P<0.01;r=0.41,P<0.02),与白蛋白呈负相关(r=-0.43,P<0.01;r=-0.57,P<0.01),与前白蛋白亦呈负相关(r=-0.47,P<0.01;r=-0.48,P<0.01);乙肝肝硬化组RDW水平与Child-Pugh评分呈正相关(r=0.67,P<0.01)。各组RDW水平与血小板、ALT、AST、HBeAg水平、HBV-DNA载量无显著相关性。结论 RDW在乙肝肝硬化患者中显著升高,能反映肝硬化患者病情的严重程度,是肝硬化病情进展的一个参考指标。

Objective To investigate the clinical significance of the red cell blood distribution width detection in patients with hepatitis B virus-related cirrhosis.Methods A retrospective analysis was conducted on 76 inpatients in the department of infectious diseases of the sixth people’s hospital of Shanghai in 2018,including 31 patients with hepatitis B virus-related cirrhosis and 45 patients with chronic hepatitis B.RDW,PLT,ALT,AST,TBIL,Albumin,Prealbumin,APTT,PT,HBeAg and HBV DNA levels were analyzed.Results The RDW was significantly higher in patients with HBV-related liver cirrhosis as compared with CHB patients and healthy controls(t=4.46,P<0.01;t=8.01,P<0.01).RDW was slightly higher in CHB patients as compared with healthy controls(t=4.97,P<0.01).The RDW values in HBV-related liver cirrhotic patients with Child-Pugh score of C was significantly higher than those with ChildPugh score of A and B(t=7.28,P<0.01;t=2.29,P<0.05),the RDW of HBV-related liver cirrhotic patients with Child-Pugh score of B was significantly higher than that of patients with the score of A(t=3.10,P<0.01).In patients with CHB and HBV-related liver cirrhosis,RDW were both positively correlated with TBIL(r=0.45,P<0.01;r=0.41,P<0.02),negatively correlated with albumin(r=-0.43,P<0.01;r=-0.57,P<0.01)and also negatively correlated with prealbumin(r=-0.47,P<0.01;r=-0.48,P<0.01).RDW level was positively correlated with Child-Pugh score in patients with HBV-related liver cirrhosis(r=0.67,P<0.01).There is no significant correlation between RDW and PLT,ALT,AST,HBeAg,HBV DNA load.Conclusion The RDW was elevated in HBV-related liver cirrhosis and was positively correlated with the severity of disease.RDW is a reference index of the progress of cirrhosis.