肝硬化患者红细胞体积分布宽度变化及其临床意义

共检测108例肝硬化患者红细胞体积分布宽度标准差(RDW—SD)和红细胞体积分布宽度变异系数(RDW—CV)。结果表明,肝硬化患者的RDW—SD和RDW—CV分别为62.3±6.9fl和21.2±2.1％,明显高于健康对照组的44.7±4.3fl和13.6±1.4％,两组比较均有显著性差异(P<0.001)。肝硬化患者中,Child B级的RDW—SD和RDW—CV高于Child A级的,Child C级的则高于Child B级的。RDW—SD和RDW—CV分别与血清白蛋白成员相关关系,与凝血酶原时间成正相关关系(P<0.001)。结果提示,肝硬化患者的RDW改变可以反映肝功能损害程度。     

红细胞体积分布宽度在心力衰竭中的研究进展

红细胞体积分布宽度（red blood cell volume disrtibution width,RDW）是反映外周血红细胞体积异质性的参数。常与平均红细胞体积（MCV）结合用于对贫血的诊断和鉴别珍断。按照美国的第三次国家卫生和营养调查的结果大于14％为异常。RDW是一个较恒定的参数,其测定值不受抗凝剂、时间和温度的影响,也不受急性炎症的影响。     

红细胞分布宽度、平均血小板体积与早发冠心病的相关性

目的探讨红细胞分布宽度(RDW)、平均血小板体积(MPV)在早发冠心病人群中的分布特征及其与冠状动脉病变严重程度的关系,评价RDW、MPV对早发冠心病的诊断价值。方法收集因胸痛发作疑诊冠心病且男性55岁、女性65岁的患者407例,经冠状动脉造影(CAG)确诊早发冠心病组309例,余98例为正常对照组。比较2组及早发冠心病各疾病亚组间的RDW、MPV水平,分析RDW、MPV与冠状动脉病变严重程度(Gensini评分)的相关性及早发冠心病的独立危险因素。结果早发冠心病组RDW、MPV水平明显高于正常对照组(P0.05),RDW、MPV在急性心肌梗死(AMI)组、不稳定型心绞痛(UAP)组和稳定型心绞痛(SAP)组均高于正常对照组(P0.05)。早发冠心病组RDW、MPV与Gensini评分之间存在正相关(r分别为0.246、0.199,P0.05);多因素Logistic回归分析显示RDW(OR=3.373,95%CI:2.197～6.359,P0.001)和MPV(OR=1.353,95%CI:1.074～1.705,P=0.010)是早发冠心病的独立危险因素。R0C曲线分析发现,RDW诊断早发冠心病的界点值为12.25%(敏感性69%,特异性72%),MPV诊断早发冠心病的界点值为8.55 fl(敏感性91%,特异性37%)。结论 RDW、MPV与早发冠心病的临床类型及冠状动脉病变的严重程度有关,是早发冠心病的独立危险因素,为早发冠心病的诊断提供一定依据。     

红细胞体积分布宽度与颈动脉粥样硬化的关系

目的探讨颈动脉粥样硬化(AS)与外周血红细胞体积分布宽度(RDW)的关系。方法选择AS患者117例,同期健康体检无AS者71例,比较两组外周血各指标的差异。采用二元Logistic回归分析AS的危险因素。绘制受试者工作特征(ROC)曲线,计算联合因子的曲线下面积(AUC)。结果两组RDW、红细胞平均体积、血小板分布宽度、血肌酐、血尿酸差异有统计学意义。采用二元Logistic回归分析AS的影响因素,RDW、红细胞平均体积、血小板分布宽度、血尿酸是颈动脉粥样硬化的危险因素。将RDW、红细胞平均体积、血小板分布宽度、血尿酸作为联合预测指标,通过Logistic回归,形成联合预测因子,其AUC=0.747(0.654～0.839),敏感性为0.780,特异性为0.625。对颈动脉内膜厚度的有序Logistic回归分析显示RDW(OR=1.61,95%CI 1.09～2.37,P=0.016)与颈动脉的内膜厚度相关。结论 RDW与颈动脉粥样硬化程度相关,动态监测RDW,有助于颈动脉粥样硬化的观察。     

冠状动脉粥样硬化性心脏病患者外周血红细胞分布宽度变化及意义

目的：观察冠状动脉粥样硬化性心脏病（简称冠心病）患者外周血红细胞分布宽度（ RDW）变化,并探讨其意义。方法452例冠心病患者（观察组）,同期健康体检者517例（对照组）,采用全自动血细胞分析仪检测外周血RDW,全自动生化分析仪检测超敏C-反应蛋白（hs-CRP）、IL-2、IL-6、肿瘤坏死因子-α（TNF-α）,Spearman相关分析法分析RDW与hs-CRP、IL-2、IL-6、TNF-α的关系,多元回归Logistic法分析冠心病发病影响及预测因素。结果观察组外周血RDW3级、RDW4级者多于对照组,观察组稳定型心绞痛患者RDW4级者多于急性冠状动脉综合征患者（P 均＜0．05）;观察组血清hs-CRP、IL-6、TNF-α水平高于对照组（P 均＜0．05）;观察组hs-CRP 与RDW1、RDW2、RDW3、RDW4呈正相关（r 分别为0．82、1．35、1．49、1．98,P 均＜0．05）;多因素Logistic 回归分析显示RDW是冠心病的独立影响及预测因素（95％CI 为5．311～9．352,P ＝0．03）。结论冠心病患者外周血RDW 升高,并随病情严重程度有增高趋势,检测此指标有助于冠心病的诊断及预后判断。     

红细胞体积分布宽度与慢性心力衰竭心功能指标关系的研究

目的:研究慢性心力衰竭(CHF)患者红细胞体积分布宽度(RDW)水平与心脏超声心功能指标的关系及临床意义。方法:选取2009-03-2010-03于辽宁医学院附属第一医院心内科住院治疗临床诊断为CHF的176例作为实验组,按照纽约心脏学会(NYHA)分级将其分为NYHAⅠ级31例、NYHAⅡ级39例、NAⅢ级52例、NYHAⅣ级54例。选取门诊健康体检者36例作为对照组。测量其RDW及左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。比较各组的RDW值;利用相关分析研究RDW与LVEDD、LVEF的关系。结果:CHF组RDW高于对照组,差异有统计学意义(P<0.01);CHF组内随着NYHA级别的增高,RDW逐渐升高,各组间两两比较差异均有统计学意义(P<0.05);RDW与LVEDD呈正相关(r=0.759,P<0.01),与LVEF呈负相关(r=-0.743,P<0.01)。结论:RDW是反映心功能受损的敏感指标,与心功能状态和左室重塑有明显的相关性,RDW的检测可对不同程度的CHF患者进行评估,对指导CHF治疗、评价预后均具有重要临床价值。     

红细胞体积分布宽度:一种新型的心血管疾病危险标记物

红细胞体积分布宽度（red cell distribution width,RDW）是反映外周血红细胞体积异质性的参数,通常以红细胞体积大小的变异系数（RDW-CV）来表示,临床上多用于缺铁性贫血的诊断和鉴别诊断.但最近研究表明,RDW是一种新型的心血管疾病危险标记物,可独立预测死亡及心血管事件发生.本文就近年来关于RDW在心脑血管疾病方面的研究进展作一综述.     

红细胞体积分布宽度与老年急性失代偿射血分数保留心力衰竭预后的关系

目的明确红细胞体积分布宽度(RDW)与老年急性失代偿射血分数保留心力衰竭(HFpEF)患者1年内预后的关系。方法入选2013年6月至2015年6月在首都医科大学附属北京友谊医院医疗保健中心心血管病房住院的125例急性失代偿HFpEF老年患者(年龄≥65岁),记录基本情况、合并疾病、用药情况,检测生化指标、超声心动图指标,检测并记录入院当日静脉血RDW。随访1年,根据1年内有无心力衰竭相关不良终点事件(心力衰竭死亡或心力衰竭再住院)分为事件组(n=38)与对照组(n=87),比较2组间各指标的差异。并根据RDW四分位区间进行分组,比较4组间临床特点及终点事件的差异。采用SPSS 16.0软件进行统计分析。应用logistic回归分析急性失代偿HFpEF相关不良预后的独立危险因素。应用受试者工作特征(ROC)曲线评价RDW预测心力衰竭不良结局的效应。结果事件组患者的RDW显著高于对照组[13.30%(12.45%,14.43%)vs 12.70%(11.50%,13.60%);P=0.022]。logistic回归显示,N末端B型利尿钠肽前体(NT-pro BNP)(OR=1.00,95%CI:1.00~1.00;P=0.010)、RDW(OR=1.19,95%CI:1.05~1.35;P=0.005)及应用袢利尿剂(OR=6.64,95%CI:2.10~20.94;P=0.001)与心力衰竭死亡和心力衰竭再住院的联合终点独立相关。随RDW水平增高,心力衰竭死亡及心力衰竭再住院联合终点事件发生率增高,差异有统计学意义(P0.05)。RDW预测联合终点的ROC曲线下面积为0.629(95%CI:0.521~0.737;P=0.022)。结论在老年急性失代偿HFpEF患者中,RDW与1年内心力衰竭死亡及心力衰竭再住院的不良预后独立相关。     

房颤患者平均血小板体积、红细胞分布宽度的变化及临床意义

目的观察心房颤动(房颤)患者平均血小板体积(MPV)和红细胞分布宽度(RDW)的变化,并探讨其临床意义。方法房颤患者68例(房颤组),同期健康体检者30例(对照组),采用全自动血细胞分析仪检测RBC、Hb、PLT、RDW、MPV。行多普勒超声心动图检查测定左心房内径(LAD)。以LAD、MPV、RDW为自变量,采用多因素Logistic回归分析法对房颤危险因素进行分析。结果房颤组MPV、RDW水平及LAD均高于对照组(P均<0.05)。多因素Logistic回归分析显示,高MPV、RDW、LAD水平为房颤的独立危险因素。结论房颤患者MPV、RDW水平升高,与房颤发病有关,在房颤预测及预后评估方面可能有一定价值。     

红细胞分布宽度在冠心病患者中的研究进展

红细胞分布宽度是测量血液循环中红细胞形态可变性的一个指标,目前其主要用于对贫血的分类诊断.近期研究表明红细胞分布宽度的升高对于心血管事件的发生风险、发展及预后的预测有密切的联系.我们着重探讨红细胞分布宽度在冠心病中的临床意义.     

Red Blood Cell Distribution Width Is Associated With All‐Cause and Cardiovascular Mortality in Hemodialysis Patients

Red blood cell distribution width (RDW) is an index of red blood cell variability that is usually used to differentiate the cause of anemia. However, clinical evidence for the relationship between RDW and mortality in hemodialysis patients is still lacking. We performed a single center, prospective longitudinal study. During more than 5 years of follow‐up in 80 patients undergoing maintenance hemodialysis, 34 patients (42.5%) died. In the Kaplan–Meier curve analyses, higher RDW levels (≥ 14.9%) were significantly associated with all‐cause and cardiovascular mortality (log‐rank test, P < 0.05, each). In multivariate Cox proportional hazard models, each 1.0% increase in RDW value predicted an estimated 25% higher risk of mortality (P < 0.05) and a 40% higher risk of cardiovascular mortality (P < 0.05). In conclusion, higher RDW value was a significant predictor for all‐cause and cardiovascular mortality in patients undergoing maintenance hemodialysis.     

血清胆红素和红细胞分布宽度在冠心病患者中的变化及意义

目的观察冠心病(CHD)患者血清胆红素(BIL)和红细胞分布宽度(RDW)的变化。方法对53例CHD患者与49例健康人采用全自动血细胞分析仪和全自动生化分析仪测定RDW、总胆红素(TBIL)、直接胆红素(DBIL)。结果 CHD组的TBIL、DBIL降低,而RDW增高,与对照组比较,差异均有显著性。结论 BIL浓度降低与CHD的发病有一定的关系,而RDW的增高,一定程度上反应了CHD血管内皮细胞的炎症反应情况,有望作为CHD随访的一项参考指标。     

急性脑梗死合并2型糖尿病患者CISS分型与血脂、红细胞分布宽度的关系

目的探讨急性脑梗死合并2型糖尿病患者的中国缺血性脑卒中分型(China Ischemic Stroke Subclassification,CISS)与血脂、红细胞分布宽度(Red Blood Cell Volume Distribution Width,RDW)的相关性。方法选择收入我院神经内科发病72小时内且合并2型糖尿病的急性脑梗死患者376例,并进行CISS分型,抽取空腹静脉血检测血总胆固醇(Total Cholesterol,TC)、甘油三酯(Triglycerides,TG)、RDW值,并分析其与CISS分型的相关性。结果 CISS分型中,大动脉粥样硬化性卒中(Large Artery Atherosclerosis,LAA)191例(50.70%),病因不确定(Undetermined Etiology,UE)103例(27.60%),其次分别为穿支动脉疾病(Penetrating Artery Disease,PAD)51例(13.50%),心源性脑卒中(Cardiogenic Stroke,CS)30例(8.00%)、其他原因所致缺血性卒中(Other Etiology,OE)1例(1.00%)。比较5种亚型TC水平,CS均低于其他4类亚型(P0.05),其余亚型两两比较无统计学意义(P0.05),存在"胆固醇悖论"现象。年龄比较,CS均高于其他4种亚型(P0.05);RDW水平比较,CS均高于其他四种类型(P0.05)。总胆固醇与CS负相关,而年龄、RDW是CS的独立危险因素(OR=1.10,2.83,均P0.01)。结论急性脑梗死合并2型糖尿病患者中以LAA及UE为主,心源性脑卒中存在"胆固醇悖论"现象,检测TC、年龄、RDW值对进行病因分型具有重要临床意义。     

红细胞分布宽度对冠心病患者预后的价值研究

目的探讨红细胞分布宽度(RDW)对冠心病(CAD)患者预后的价值。方法收集本院2008年3月—2010年5月155例因CAD住院的患者,并进行冠状动脉造影以明确诊断。根据入院24h的首次RDW,按照其中位数(13.7%)将患者分为两组:A组(RDW≤13.7%,n=78)和B组(RDW>13.7%,n=77),比较两组患者住院期间及出院1年内发生再次心肌梗死、新发心力衰竭、心源性死亡等不良心血管事件的差异。结果 B组发生再次心肌梗死、新发心力衰竭、心源性死亡发生率均高于A组,差异有统计学意义(P<0.05)。结论 RDW对CAD预后有一定价值,RDW水平较高的CAD患者预后较差。     

Red Blood Cell Distribution and Survival in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background: Cardiovascular disease (CVD) contributes significantly to mortality in chronic obstructive pulmonary disease (COPD). Red blood cell distribution width (RDW), an automated measure of red blood cell size heterogeneity that is largely overlooked, is a newly recognized mortality marker in patients with established CVD. It is unknown whether RDW is associated with mortality in COPD patients.

Aims: To study the prognostic value of RDW in patients with COPD and to compare the value of this measurement with cardiac, respiratory, and hemotological status. Method: We performed retrospective analyses of 270 patients stable with COPD who were admitted to our hospital between January 2007 and December 2009. Demographic, clinical, echocardiographic, and laboratory characteristics were registered and recorded COPD deaths were registered as outcomes. Results: In the overall patients, the RDW level had a mean value of 15.1 ± 2.4. RDW was positively correlated with C-reactive protein (CRP) (p = 0.008, r = 0.21), right ventricular dysfunction (RVD) (p < 0.001, r = 0.25), and pulmonary arterial hypertension (PAH) (p = 0.03, r = 0.14). Variables (p < 0.1) included in the univariate survival analysis were forced expiratory volume in 1 second (FEV1% predicted), RDW levels, age, PaCO2, albumine and CRP levels, presence of CVD, presence of anemia, presence of RVD, and presence of PAH. Subsequent multivariate analysis suggested that RDW levels (1.12; 95% CI, 1.01 to 1.24; p = 0.01), and presence of RVD (2.6; 95% CI, 1.19 to 5.8; p = 0.01) were independently related to mortality. Conclusion: Elevated RDW levels were associated with increased mortality risk in stable COPD patients.     

Reticulocyte Hemoglobin Equivalent (Ret-He) Combined with Red Blood Cell Distribution Width Has a Differentially Diagnostic Value for Thalassemias

Abstract

As a type of congenital microcytic hypochromic anemia, thalassemia trait is often confused with other conditions, such as congenital sideroblastic anemia (CSA) and iron deficiency anemia, before a specific work-up is performed. However, these tests, including hemoglobin (Hb) electrophoresis, gene mutations and Prussian blue staining after bone marrow aspirate, are relatively expensive, time-consuming and invasive. To find labor-saving parameters to facilitate differential diagnosis, we retrospectively analyzed the routine blood indexes of 59 thalassemia trait cases [22 α-thalassemia (α-thal), 36 β-thalassemia (β-thal) and one α/β-thal], 21 CSA patients, and 238 iron deficiency anemia controls. Significantly higher reticulocyte Hb equivalent (Ret-He) and lower red blood cell (RBC) distribution width (RDW) were prominent in thalassemia trait. Furthermore, RDW-standard deviation (SD) was independent of the severity of anemia in thalassemia trait, similar to Ret-He in CSA. In the context of the same grades of anemia, Ret-He combined with RDW was powerful in differentiation of thalassemia from CSA and iron deficiency anemia. By receiver operation curve (ROC) analysis, Ret-He had a specificity of 67.06% and a sensitivity of 76.92% with a cutoff value of 20.9?pg for thalassemia trait in mild anemia and a specificity of 84.09% and a sensitivity of 68.42% with a cutoff value of 19.1?pg for thalassemia trait in moderate anemia. Regarding CSA, Ret-He had 92.94% specificity and 60.00% sensitivity in mild anemia, with a cutoff value of 18.1?pg. Overall, Ret-He and RDW are two convenient indexes able to differentiate thalassemia from the other two microcytic anemias, CSA and iron deficiency anemia.     

Red Cell Distribution Width for Assessment of Activity of Inflammatory Bowel Disease

Background Impaired iron absorption or increased loss of iron was found to correlate with disease activity and markers of inflammation in inflammatory bowel disease (IBD). Red cell distribution width (RDW) could be a reliable index of anisocytosis with the highest sensitivity to iron deficiency. Aim The importance of RDW in assessment of IBD disease activity is unknown. In this study, we aimed to determine if RDW could be useful in detecting active disease in patients with IBD. Materials and methods A total of 74 patients with ulcerative colitis (UC) and 22 patients with Crohn’s disease (CD) formed the study group with 20 age- and sex-matched healthy volunteers as the control group. CD activity index higher than 150 in patients with CD was considered to indicate active disease. Patients with moderate and severe disease according to the Truelove-Witts scale were accepted as having active UC. In addition to RDW, serum C-reactive protein (CRP) and fibrinogen levels, erythrocyte sedimentation rates (ESR), leukocyte, and platelet counts were measured. Results Fourteen (63.6%) of the patients with CD and 43 (58.1%) of the patients with UC had active disease. RDW, fibrinogen, CRP, ESR, and platelet counts were all significantly elevated in patients having active IBD compared with those without active disease and controls (P < 0.05). The study subjects were further classified into two subgroups: cases with active and inactive UC and those with active and inactive CD. A subgroup analysis indicated that for an RDW cutoff of 14, the sensitivity for detecting active UC was 88% and the specificity was 71% (area under curve [AUC] 0.81, P = 0.0001). RDW was the most sensitive and specific parameter indicating active UC. However, the same was not true for CD since CRP at a cutoff of 0.54 mg/dl showed a sensitivity of 92% and a specificity of 63% (AUC 0.92, P = 0.001), whereas RDW at a cutoff of 14.1 showed 78% sensitivity and 63% specificity to detect active CD. Conclusion Among the laboratory tests investigated, including fibrinogen, CRP, ESR, and platelet counts, receiver operating characteristic (ROC) curve analysis indicated RDW to be the most significant indicator of active UC. For CD, CRP was an important marker of active disease.