王飞 丁勇 姜婷婷 游达礼 杨炳华 徐峰 吴晓

DOI：10.3760/cma.j.issn.1671-0282.2014.08.015

作者单位：201800 上海，上海市嘉定区中心医院急诊科（王飞、姜婷婷、游达礼、杨炳华、徐峰、吴晓）；嘉定区社会健康服务中心（丁勇）

通信作者：吴晓，Email：wx5187@aliyun.com

【摘要】目的 探讨危重患者的红细胞分布宽度（RDW）与疾病危重程度的关系及对预后的判断作用。

访法 采用前瞻性、临床病例观察和诊断性试验研究。选择自2011年2月到2013年5月间，收住急诊ICU的196例危重患者。在入ICU第一个24 h内抽取静脉血检测血常规（包括红细胞分布宽度），同时根据患者即时情况及各生化指标进行急性生理学和慢性健康状况评分（APACHEⅡ评分）。根据临床转归分为两组，即存活组（n=126）和死亡组（n=70），单因素方差分析比较两组间APACHEⅡ评分及RDW水平的差异性。采用Spearman法对RDW及APACHE Ⅱ评分进行相关性分析。分别建立RDW和APACHEⅡ评分预测患者死亡的受試者工作特征（ROC）曲线。以约登指数法找到RDW和APACHEⅡ预测死亡的最佳截断值。

结果 死亡组患者入院时的APACHEⅡ评分与RDW水平均显著高于存活组，分别为（20.43±6.41 ）vs. （13.94±6.77）和（13.35±2.21）vs. （11.34±1.32），P值均小于0.01；RDW与APACHEⅡ评分呈显著正相关关系（相关系数r=0.309，P< 0.01）；分别用RDW及APACHEⅡ预判死亡，其ROC曲线下面积及95%可信区间分别为0.792（0.725，0.860）和0.754（0.686，0.822），其最佳截断值分别是12.35和17.5，预判准确性分别为76.5%和70.4%。本组病例中有12名红细胞分布宽度超过15.4的患者均死亡。

结论 危重患者入住ICU时的RDW水平与疾病危重程度有非常密切的关系，对判断预后有重要参考价值。

【关键词】红细胞分布宽度；危重病；APACHEⅡ评分；危重程度；预后；相关性；诊断性试验；约登指数

Red cell distribution width correlates with prognosis and severity of critical illness among medical patientsWang Fei， Ding Yong， Jiang Tingting， You Dali， Yang Binghua， Xu Feng， Wu Xiao Department of Emergency， Central Hospital of Jiading District， Shanghai 201800， ChinaCorresponding author：Wu Xiaoc，Email：wx5187@aliyun.com

【Abstract】Objective Toinvestigate the prognostic value of red cell distribution width （RDW） and relationship between RDW and severity of critical illness patients and prognostic role of RDW. Methods This was a prospective observational and diagnostic test study. From February 2011 to May 2013， 196 medical patients in ICU were enrolled to study. Blood samples were taken within 24 hrs after admission to ICU for blood routine test and other chemical routine test， including RDW. Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score were also calculated. The patients were divided into survival group （n=126） and death group （n=70） based on their hospital outcomes.Differences in RDW levels and APACHE Ⅱ score between survival and death groups were compared with One-way ANOVA. The correlation between RDW and APACHE Ⅱ score were analyzed by Spearman correlation test. Receiver operator curve （ROC） test was used to determine the predictive value of RDW and APACHE Ⅱ for hospital death. Results Both RDW level and APACHE Ⅱ score were significantly higher in death group than those in survival group， which were （13.35±2.21 ） vs. （11.34±1.32） and （20.43±6.41） vs. （13.94±6.77） respectively （ both P<0.01 ）. RDW significantly correlated with APACHE Ⅱ score （r=0.309， P<0.01）. To predict hospital death area under curve （AUC） of ROC curve by RDW and APACHE Ⅱ score were 0.792（0.725，0.860）and 0.754（0.686，0.822） respectively. The best cut-off value was determined by Yoden Index were 12.35 for RDW and 17.5 for APACHE Ⅱ score. The Accuracy of prediction was 76.5% and 70.4% respectively. In addition， all the 12 patients whose RDW level >15.4 were dead. Conclusion RDW level at admission to ICU correlate well with the severity of critical illness. RDW level has an additional predictive value for the prognosis of critical ill patients.

【Key words】Red cell distribution width； Critical illness；APACHEⅡscore；Severity of critical illness； Prognosis； Correlation；Diagnostic test；Yoden Index

危重病患者因各种疾病可导致机体代谢发生一系列变化。红细胞分布宽度（RDW）是反映血液循环中外周血细胞异质性的一个指标，常用于贫血^[1]的诊断、鉴别诊断和疗效观察。近年来，有研究显示RDW和多种心血管疾病的严重程度及预后有关^[2-5]。……