红细胞体积分布宽度及白细胞介素6水平对急性呼吸窘迫综合征患者预后的评估价值

Evaluation value of red blood cell distribution width and interleukin-6 in the prognosis of patients with acute respiratory distress syndrome

目的探讨红细胞体积分布宽度(RDW)、白细胞介素6(IL-6)水平对急性呼吸窘迫综合征(ARDS)患者预后的评估价值。方法收集2018年1月至2020年1月于首都医科大学附属北京友谊医院就诊的96例ARDS患者的临床资料,根据预后情况分为存活组(46例)和死亡组(50例)。比较2组患者RDW、IL-6及一般临床资料的差异,探讨ARDS患者死亡的影响因素,分析RDW、IL-6对ARDS患者死亡的诊断效能。结果死亡组患者的年龄、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、白细胞计数、C反应蛋白水平明显高于存活组,而氧合指数明显低于存活组,差异均有统计学意义(均P<0.05)。死亡组患者的RDW、IL-6明显高于存活组[(17±4)%比(13±3)%、(215±38)ng/L比(80±22)ng/L],差异均有统计学意义(均P<0.001)。Logistic多因素回归分析显示年龄(比值比=1.876)、RDW(比值比=2.133)、IL-6(比值比=1.978)及APACHEⅡ评分(比值比=1.655)均是ARDS患者死亡的影响因素(均P<0.05)。RDW、IL-6诊断ARDS患者死亡的受试者工作特征曲线下面积分别为0.826、0.877,最佳截断值分别为14.32%、178.47 ng/L,二者联合诊断的曲线下面积为0.951,高于任一单项指标(均P<0.001)。结论RDW、IL-6对ARDS患者预后均具有较好的预测价值,二者联合检测有助于早期评估患者病情以改善预后。

Objective To investigate the evaluation value of red blood cell distribution width(RDW)and interleukin-6(IL-6)in the prognosis of patients with acute respiratory distress syndrome(ARDS).Methods A total of 96 patients with ARDS admitted to Beijing Friendship Hospital,Capital Medical University from January2018 to January 2020 were selected.According to the prognosis,they were divided into survival group(46 cases)and death group(50 cases).The differences of RDW,IL-6 and general clinical data between the two groups were compared,the influencing factors of the death of ARDS patients and the diagnostic efficacy of RDW and IL-6 on the death of ARDS patients were analyzed.Results The age,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,white blood cell count,and C-reactive protein levels of patients in the death group were significantly higher than those in the survival group,while the oxygenation index was significantly lower than that in the survival group(all P<0.05).The levels of RDW and IL-6 in the death group were significantly higher than those in the survival group[(17±4)%vs(13±3)%,(215±38)ng/L vs(80±22)ng/L],and the differences were statistically significant(both P<0.001).Multivariate Logistic regression analysis showed that age(odds ratio=1.876),RDW(odds ratio=2.133),IL-6(odds ratio=1.978)and APACHEⅡscore(odds ratio=1.655)were risk factors for the death of ARDS patients(all P<0.05).The areas under the receiver operating characteristic curve of the diagnosis of ARDS by RDW and IL-6 were 0.826 and 0.877,the best cutoff values were 14.32%and178.47 ng/L respectively,and the AUC of the combined diagnosis of the RDW and IL-6 was 0.951,higher than any single indicator(all P<0.001).Conclusion Both RDW and IL-6 have good predictive value for the prognosis of ARDS patients,and the combined detection of them is helpful for the early assessment of the patients’condition and improve the prognosis.