红细胞分布宽度对肝泡型包虫病术后预测价值分析

Analysis of the postoperative predictive value of red blood cell distribution width for hepatic alveolar hydatid disease

目的探讨肝脏泡型包虫病术前红细胞分布宽度(RDW)的预后价值。方法回顾性分析210例肝包虫手术患者的临床资料;收集患者红细胞分布宽度变异系数(RDW-CV)值,绘制受试者工作特征曲线(ROC),并计算曲线下面积(AUC),判断最佳临界值;根据该临界值将210例患者分为低RDW组126例与高RDW组84例。分析两组患者的手术方式、有无坏死、术前治疗、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白、总胆红素(TBil)、碱性磷酸酶(ALP)、谷氨酰基转移酶(GGT)、凝血酶原时间(PT)、Child-Pugh分级、生存曲线的差异性。采用COX回归模型进行单因素及多因素分析影响患者预后的因素,并计算风险比(HR)及对应的95%CI。结果两组患者手术方式、有无坏死、术前治疗、ALT、AST、白蛋白、TBil、ALP、GGT、PT、Child-Pugh分级差异均有统计学意义(P<0.05);两组患者平均生存时间差异有显著统计学意义(P<0.05);低RDW组1、3、5年生存率均明显高于RDW组(χ^(2)=29.054,P<0.001);单因素COX回归结果显示年龄、手术方式、TBil、ALP、PT、Child-Pugh分级、RDW与肝泡性包虫病患者预后相关(P<0.05);多因素Cox回归模型显示年龄、TBil、RDW是影响肝泡型包虫病患者预后的独立危险因素。结论RDW-CV是肝泡性包虫病患者术后的预后指标,术前外周血RDW-CV越低,患者预后越好。

Objective To investigate the prognostic value of preoperative red blood cell distribution width(RDW)for hepatic alveolar hydatid disease.Methods Clinical data of 210 patients undergoing hepatic hydatid surgery were retrospectively analyzed.The coefficient of variation of red blood cell distribution width(RDW-CV)was collected.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was calculated to determine the best cut-off value.The patients were divided into a low RDW group(n=126)and a high RDW group(n=84)according to this cut-off value.The differences in surgical methods,presence or absence of necrosis,preoperative treatment,alanine amin-otransferase(ALT),aspartate aminotransferase(AST),albumin,total bilirubin(TBil),alkaline phosphatase(ALP),Gamma-glutamyltransferase(GGT),prothrombin time(PT),Child-Pugh classification,and survival curves of the two groups were analyzed.The COX regression model was used to analyze the factors affecting the patient′s prognosis by using univariate and multivariate models,and calculate the hazard ratio(HR)and the corresponding 95%CI.Results There were significant differences in surgical methods,presence or absence of necrosis,preoperative treatment,ALT,AST,albumin,TBil,ALP,GGT,PT,and Child-Pugh grades between the two groups(P<0.05).There was significant difference in the average survival time between the two groups(P<0.05).The 1,3,and 5-year survival rates in the low RDW group were obviously higher than those in the high RDW group(χ^(2)=29.054,P<0.001).The univariate COX regression analysis showed that age,surgical methods,TBil,ALP,PT,Child-Pugh classification,RDW and hepatic alveolar were correlated with the prognosis of echinococcosis patients(P<0.05).The multivariate Cox regression analysis showed that age,TBil and RDW were independent risk factors for the prognosis of the patients with alveolar hydatid disease.Conclusion RDW-CV is a prognostic indicator for patients with alveolar echinococcosis after surgery.The lower the preoperative peripheral blood RDW-CV is,the better the prognosis of patients is.