上消化道出血患者RDW、D-二聚体与出血量、病情程度的关系及联合检测的临床指导价值

The relationship between RDW,D-dimer,bleeding volume and disease degree in patients with upper gastrointestinal bleeding and the clinical guiding value of combined detection

目的探究上消化道出血(UGIB)患者红细胞分布宽度(RDW)、D-二聚体(D-D)与出血量、病情程度的关系及联合检测的临床指导价值。方法选取河北北方学院附属第一医院2017年4月—2020年7月UGIB患者123例,随访30 d,根据是否发生上消化道再出血分为再出血组(21例)与未再出血组(102例)。比较两组一般资料、治疗前后RDW、D-D水平、不同情况患者治疗前后RDW、D-D水平,分析RDW、D-D与出血量、病情程度的关系、UGIB患者发生再出血的影响因素,评价治疗前后RDW、D-D单独及联合检测对上消化道再出血的预测价值。结果两组年龄、吸烟、饮酒、出血量、病情程度差异有统计学意义(P<0.05);再出血组治疗前、治疗3 d、7 d后RDW、D-D水平高于对照组(P<0.05);两组治疗前、治疗3 d、7 d后RDW、D-D水平呈降低趋势(P<0.05);不同出血量、病情程度患者治疗前、治疗3 d与7 d后RDW、D-D水平呈降低趋势(P<0.05);Spearman相关性分析,治疗前、治疗3 d与7 d后RDW、D-D与出血量、病情程度呈正相关(P<0.05);Logistic回归分析年龄,吸烟、饮酒、治疗前、治疗3 d与7 d后RDW、D-D是UGIB患者发生再出血的重要影响因素(P<0.05);ROC曲线分析,将治疗前、治疗3 d与7 d后RDW、D-D分别进行Logistic二元回归拟合,返回预测概率Log⁃it(P)作为独立检验变量,获取联合预测AUC分别为0.809(95%CI为0.729~0.875)、0.830(95%CI为0.729~0.875)、0.898(95%CI为0.831~0.945),敏感度分别为76.19%、80.95%、90.48%,特异度分别为75.49%、76.47%、77.45%,均优于同一时间点两者单独预测价值(P<0.05)。结论UGIB患者RDW、D-D与出血量、病情程度呈正相关,治疗期间联合检测能有效预测上消化道再出血,对制定或调整治疗方案具有重要指导意义。

Objective To explore the relationship between red blood cell distribution width(RDW),D-dimer(D-D),bleeding volume and severity of upper gastrointestinal bleeding(UGIB)patients,and the clinical guiding value of combined detection.Methods A total of 123 patients with UGIB in our hospital from April 2017 to July 2020 were selected.Follow-up for 30 d,according to whether upper gastrointestinal rebleeding occurred,they were divided into rebleeding group(21 cases)and non-rebleeding group(102 cases).The general data,RDW and D-D levels before and after treatment,and RDW and D-D levels of patients with different conditions before and after treatment were compared between the two groups.The relationship between RDW,D-D,bleeding volume,disease severity,and the influencing factors of rebleeding in UGIB patients were analyzed,and the predictive value of RDW,D-D alone and combined detection before and after treatment on upper gastrointestinal rebleeding was evaluated.Results There were statistically significant differences in age,smoking,drinking,bleeding volume,and severity of illness between the two groups(P<0.05).The RDW and D-D levels of the rebleeding group before treatment,3 d,and 7 d after treatment were higher than those of the control group(P<0.05).The RDW and D-D levels of the two groups showed a decreasing trend before treatment,3 d,and 7 d after treatment(P<0.05).The RDW and D-D levels of patients with different bleeding volume and disease severity before treatment,3 d and 7 d after treatment showed a decreasing trend(P<0.05).Spearman correlation analysis showed that RDW and D-D were positively correlated with bleeding volume and disease severity before treatment,3 d and 7 d after treatment(P<0.05).Logistic regression analysis showed that age,smoking,drinking,RDW and D-D before treatment,3 d and 7 d after treatment were important influencing factors for rebleeding in UGIB patients(P<0.05).ROC curve analysis,the RDW and D-D before treatment,3 d,and 7 d after treatment were fitted with Logistic binary regression,and the predicted probability Logit(P)was returned as an independent test variable.The AUC obtained for the joint prediction were 0.809(95%CI 0.729~0.875),0.830(95%CI 0.729~0.875),0.898(95%CI 0.831~0.945).The sensitivities were 76.19%,80.95%,and 90.48%,and the specificities were 75.49%,76.47%,and 77.45%,respectively,which were better than the predictive value of the two alone at the same time point(P<0.05).Conclusion RDW and D-D of UGIB patients are positively correlated with bleeding volume and disease severity.Combined detection during treatment can effectively predict upper gastrointestinal rebleeding,which has important guiding significance for formulating or adjusting treatment plans.