红细胞分布宽度在慢性阻塞性肺疾病急性加重患者中的临床意义
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摘要
目的探讨红细胞分布宽度(RDW)在慢性阻塞性肺部疾病急性加重期(AECOPD)中的临床意义。方法收集80例AECOPD住院患者、42例慢阻肺门诊随诊患者、50例健康对照组的资料,对比RDW、红细胞计数(RBC)、血红蛋白(Hb)的差异。AECOPD患者中根据肺功能GOLD分级分为GOLDⅡ级、GOLDⅢ级、GOLDⅣ级,对比三组的RDW、RBC、Hb;AECOPD中按是否合并二氧化碳(CO_2)潴留、肺动脉高压分为A组(既无CO_2潴留又无肺动脉高压)、B组(单纯CO_2潴留)、C组(单纯肺动脉高压)、D组(合并CO_2潴留、肺动脉高压),比较四组RDW水平,并分析AECOPD患者住院总时间、住院总费用与RDW的相关性。结果1.RDW水平在AECOPD组、慢阻肺组、健康对照组中差异有统计学意义(P<0.05),RBC、Hb在三组中差异无统计学意义(P>0.05);2.AECOPD中按GOLD分级:GOLDⅡ级、GOLDⅢ级、GOLDⅣ级三组RDW水平差异有统计学意义(P<0.05),RBC、Hb差异无意义(P>0.05),三组RDW水平Ⅳ级(13.6±1.3)%>Ⅲ级(13.2±1.1)%>Ⅱ级(12.6±0.7)%;3.AECOPD中按是否合并二氧化碳(CO_2)潴留、肺动脉高压:四组RDW水平差异有统计学意义(P<0.05);4.RDW值与住院总时间、住院总费用呈正相关(r=0.836,P=0.00;r=0.766,P=0.00)。结论 RDW可被视作是评估AECOPD患者病情严重程度的标志物。
Objective To explore the clinical significance of red blood cell distribution width (RDW) in patients with AECOPD. Methods The clinical data of 80 AECOPD patients,42 COPD outpatients and 50 healthy controls were compared with RDW,red blood cell count (RBC),and hemoglobin (Hb). According to lung function GOLD classification,the 80 AECOPD patients were divided into the GOLD II,GOLD III and GOLD Ⅳ groups,and then their RDW,RBC and Hb were compared. According to whether complicated with carbon dioxide (CO_2) retention or pulmonary artery hypertension,they were divided into the group A (neither CO_2 retention nor pulmonary hypertension),the group B (only CO_2retention),the group C (only pulmonary hypertension),and the group D (CO_2 retention and pulmonary artery high pressure),and their RDW was compared. The correlation of RDW with total duration of hospital stay and total hospitalization expense was analyzed. Results 1. The value of RDW showed significant difference among the AECOPD group,the COPD group and the control group (P < 0. 05),but Hb and RBC hadno statistical significance (P>0. 05). 2. The value of RDW showed significant differences among the GOLD II,GOLD III,and GOLD Ⅳ groups (P<0. 05),and it decreased progressively in the three groups. Differences in the level of RBC and Hb were no significant among the three groups (P>0. 05). 3. The value of RDW was statistically significant in AECOPD patients according to whether complicated with CO_2 retention and pulmonary hypertension or not (P<0. 05). 4. The value of RDW was positively correlated with the total duration of hospital stay and the total cost of hospitalization. Conclusion RDW can be regarded as a severity marker for patients with AECOPD.
Objective To explore the clinical significance of red blood cell distribution width (RDW) in patients with AECOPD. Methods The clinical data of 80 AECOPD patients,42 COPD outpatients and 50 healthy controls were compared with RDW,red blood cell count (RBC),and hemoglobin (Hb). According to lung function GOLD classification,the 80 AECOPD patients were divided into the GOLD II,GOLD III and GOLD Ⅳ groups,and then their RDW,RBC and Hb were compared. According to whether complicated with carbon dioxide (CO_2) retention or pulmonary artery hypertension,they were divided into the group A (neither CO_2 retention nor pulmonary hypertension),the group B (only CO_2retention),the group C (only pulmonary hypertension),and the group D (CO_2 retention and pulmonary artery high pressure),and their RDW was compared. The correlation of RDW with total duration of hospital stay and total hospitalization expense was analyzed. Results 1. The value of RDW showed significant difference among the AECOPD group,the COPD group and the control group (P < 0. 05),but Hb and RBC hadno statistical significance (P>0. 05). 2. The value of RDW showed significant differences among the GOLD II,GOLD III,and GOLD Ⅳ groups (P<0. 05),and it decreased progressively in the three groups. Differences in the level of RBC and Hb were no significant among the three groups (P>0. 05). 3. The value of RDW was statistically significant in AECOPD patients according to whether complicated with CO_2 retention and pulmonary hypertension or not (P<0. 05). 4. The value of RDW was positively correlated with the total duration of hospital stay and the total cost of hospitalization. Conclusion RDW can be regarded as a severity marker for patients with AECOPD.
引文
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[14]张鹏,齐保龙,孙耕耘.血清C-反应蛋白和红细胞分布宽度在AECOPD与稳定期的变化及意义[J].临床肺科杂志,2015,20(1):16-18.
[15]颜丽莎,徐爱晖.红细胞体积分布宽度与慢阻肺急性加重期患者病情严重程度的相关性[J].临床肺科杂志,2016,21(1):54-60.
[2]Demir A,Yarali N,Fisgin T,et al.Most reliable indices in differentiation between thalassemia trait and iron deficiency anemia[J].Pediatr Int,2002,44(6):612-616.
[3]Hampole CV,Mehrotra AK,Thenappan T,et al.Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension[J].Am J Cardiol,2009,104(6):868-872.
[4]Allen LA,Felker GM,Mehra MR,et al.Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure[J].J Card Fail,2010,16(3):230-238.
[5]Tonelli M,Sacks F,Arnold M,et al.Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease[J].Circulation,2008,117(2):163-168.
[6]Vestbo J,Hurd SS,AgustíAG,et al.Global strategy for the diagnoiss,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J].Am J Respir Crit Care Med,2013,187(4):347-365.
[7]Maclay JD,Mc Allister DA,Macnee W.Cardiovascular risk in chronic obstructive pulmonary disease[J].Respirology,2007,12(5):634-641.
[8]Rhodes CJ,Wharton J,Howard LS,et al.Red cell distribution width outperforms other potential circulating biomarkers in predicting survival in idiopathic pulmonary arterial hypertension[J].Heart,2011,97(13):1054-1060.
[9]Seyhan EC,?zgül MA,Tutar N,et al.Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease[J].COPD,2013,10(4):416-424.
[10]王金艳,洪波,孙珍贵,等.红细胞分布宽度与慢性阻塞性肺部疾病继发肺动脉高压的相关性研究[J].国际呼吸杂志,2014,34(17):1301-1303.
[11]Tertemiz KC,Ozgen Alpaydin A,Sevinc C,et al.Could“red cell distribution width”predict COPD severity?[J].Rev Port Pneumol(2006).,2016,22(4):196-201.
[12]Zorlu A,Bektasoglu G,Guven FM,et al.Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism[J].Am J Cardiol.2012;109(1):128-134.
[13]杨妮,柯蕊,刘原.红细胞分布宽度在肺部疾病中的临床价值[J].国际呼吸杂志,2015,35(11):874-877.
[14]张鹏,齐保龙,孙耕耘.血清C-反应蛋白和红细胞分布宽度在AECOPD与稳定期的变化及意义[J].临床肺科杂志,2015,20(1):16-18.
[15]颜丽莎,徐爱晖.红细胞体积分布宽度与慢阻肺急性加重期患者病情严重程度的相关性[J].临床肺科杂志,2016,21(1):54-60.