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.     

冠心病患者红细胞分布宽度与炎性标志物的关系

目的:探究冠状动脉粥样硬化性心脏病(冠心病)患者红细胞分布宽度(RDW)与炎性标志物水平之间的关系。方法:入选行冠状动脉造影术的1 047例患者,进行超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)检测及超声心动图检查。将患者分为冠心病及非冠心病组,在冠心病组中将患者分为稳定性心绞痛(SA)及急性冠状动脉综合征(ACS)组,并以四分位数法将冠心病组按RDW值分为Q1～Q4四组。结果:本研究共入选1 047例患者,冠心病组RDW及hs-CRP水平显著高于非冠心病组。冠心病组中,ACS组患者RDW值较SA组明显升高,而炎性标志物水平仅有升高趋势。冠状动脉3支病变患者RDW值较单支病变患者有升高趋势。冠心病组中,Q4组患者hs-CRP水平较Q1组显著升高,RDW与hs-CRP水平呈正相关(r=0.121,P=0.025)。结论:冠心病患者RDW值升高,其中ACS组患者较SA组进一步升高,并且冠心病患者RDW值与炎性标志物水平相关(r=0.142,P=0.009)。     

红细胞分布宽度是预测冠状动脉粥样硬化性心脏病危险的标志物

<正>冠状动脉粥样硬化性心脏病(CAD)是严重威胁人类生命健康的重大疾病,其防治是全世界共同面临的重大的公共卫生问题。近些年来,我国的CAD发病率、住院率和院前死亡率持续攀升,目前每年有超过70万人死于CAD,1998至2008年间我国男性CAD发病率增加26.1%,女性CAD发病     

Red cell distribution width to platelet ratio: New and promising prognostic marker in acute pancreatitis

AIM: To evaluate the accuracy of red cell distribution width (RDW) to platelet ratio (RPR) to predict in-hospital mortality in acute pancreatitis (AP).METHODS: Between January 2010 and June 2012, 102 patients with AP were recruited to the study. In this retrospective cohort study, for all subjects, demographic data on hospital admission, AP etiology, co-morbid diseases, organ failure assessment, laboratory parameters and length of hospital stay were examined. Additionally, we used a non-invasive prediction method in addition to the RPR to evaluate the disease severity. Multivariate logistic regression analyses were used to evaluate the impact of RPR on hospital admission to predict mortality.RESULTS: The male-female ratio (59/43) was 1.37 with a median age of 56.5 years (17-89 years). In both univariate and multivariate analyses, RDW and RPR were presented as independent and significant variables on admission to predict mortality. The RPR obtained on hospital admission was persistently higher among non-survivors than among survivors (P < 0.0001). The median RPR was 0.000087 in the non-survivor group and 0.000058 in the survivor group. RPR with a cutoff value of 0.000067 presented an area under the curve of 0.783 (95%CI: 0.688-0.878) in receiver operating characteristic curves and could predict the mortality of approximately 80% of the patients.CONCLUSION: We identified RPR as a valuable, novel laboratory test to predict mortality in AP.     

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.     

Red cell distribution width and nonalcoholic steatohepatitis

Red cell distribution width is a measure of deviation of the volume of red blood cells.It is a marker of anisocytosis and often used to evaluate the possible causes of anemia.Elevated red cell distribution width levels are also associated with acute and chronic inflammatory responses.In nonalcoholic steatohepatitis,inflammation is accompanied with steatosis.For assuming red cell distribution width as a marker of nonalcoholic steatohepatitis,intervening factors such as levels of inflammatory markers should also be evaluated.     

Red blood cell distribution width in elderly hospitalized patients with cardiovascular disease

BACKGROUNDRed blood cell distribution width (RDW) is elevated in patients with cardiovascular disease (CVD).AIMTo determine RDW values and impact of CV and non-CV coexisting morbidities in elderly patients hospitalized with chronic CVD.METHODSThis prospective study included 204 consecutive elderly patients (age 77.5 [7.41] years, female 94 [46%], left ventricular ejection fraction 53.00% [37.50, 55.00]) hospitalized with chronic CVD at the Cardiology Department of Larissa University General Hospital (Larissa, Greece) from January 2019 to April 2019. Elderly patients were selected due to the high prevalence of coexisting morbidities in this patient population. Hospitalized patients with acute CVD (acute coronary syndromes, new-onset heart failure [HF], and acute pericarditis/myocarditis), primary isolated valvular heart disease, sepsis, and those with a history of blood transfusions or cancer were excluded. The evaluation of the patients within 24 h from admission included clinical examination, laboratory blood tests, and echocardiography.RESULTSThe most common cardiac morbidities were hypertension and coronary artery disease, with acutely decompensated chronic heart failure (ADCHF) and atrial fibrillation (AF) also frequently being present. The most common non-cardiac morbidities were anemia and chronic kidney disease followed by diabetes mellitus, chronic obstructive pulmonary disease, and sleep apnea. RDW was significantly elevated 15.48 (2.15); 121 (59.3%) of patients had RDW > 14.5% which represents the upper limit of normal in our institution. Factors associated with RDW in stepwise regression analysis were ADCHF (coefficient: 1.406; 95% confidence interval [CI]: 0.830-1.981; P < 0.001), AF (1.192; 0.673 to 1.711; P < 0.001), and anemia (0.806; 0.256 to 1.355; P = 0.004). ADCHF was the most significant factor associated with RDW. RDW was on average 1.41 higher for patients with than without ADCHF, 1.19 higher for patients with than without AF, and 0.81 higher for patients with than without anemia. When patients were grouped based on the presence or absence of anemia, ADCHF and AF, heart rate was not increased in those with anemia but was significantly increased in those with ADCHF or AF.CONCLUSIONRDW was elevated in elderly hospitalized patients with chronic CVD. Factors associated with RDW were anemia and CV factors associated with elevated heart rate (ADCHF, AF), suggesting sympathetic overactivity.     

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation(AF) patients at higher risk. The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width(RDW) in AF. A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations.Data abstraction was conducted on a final number of 35 articles(13 crosssectional, 12 prospective and 10 retrospective studies). The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis,thromboembolic events and mortality. AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed, in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.     

Red blood cell distribution width and cardiovascular diseases

Background

The red blood cell distribution width (RDW) is a rather simple measure of red blood cell (RBC) size heterogeneity (i.e., anisocytosis), which is easily calculated by dividing the standard deviation (SD) of erythrocyte volumes for the mean corpuscular volume (MCV). Emerging evidence suggests that, besides RBC abnormalities, many human disorders may be frequently associated with a high degree of anisocytosis.

Methods

In this narrative review, we analyzed the current scientific literature about the putative role and the potential epidemiologic association between RDW and cardiovascular diseases. The findings of the most representative epidemiological studies were summarized and discussed.

Results

Overall, considerable and convincing evidence has been brought that an increased RDW value is associated with acute coronary syndrome (ACS) [including acute myocardial infarction (AMI)], ischemic cerebrovascular disease (including stroke), peripheral artery disease (PAD), as well as with atrial fibrillation (AF), heart failure (HF) and hypertension. Higher anisocytosis also significantly and independently predicts adverse outcomes in patients with these conditions.

Conclusions

Although the role of anisocytosis in the pathogenesis of cardiovascular diseases remains uncertain, the considerable evidence available so far suggests that the clinical use of RDW may be broadened beyond the conventional boundaries of erythrocyte disorders, in particular for assisting the diagnosis and prognostication of patients with ACS, ischemic cerebrovascular disease, PAD, HF and AF.     

Red blood cell distribution width and diabetes-associated complications

AimRed blood cell distribution width (RDW) is a marker of cardiovascular morbidity and mortality. However, there is little data on the relationship between RDW and diabetes-associated complications. The aim was to investigate whether there is any association between RDW, nephropathy, neuropathy and peripheral arterial disease (PAD) in a type 2 diabetic population.MethodsThis study included 196 diabetic patients with proliferative diabetic retinopathy. All subjects were investigated for diabetic nephropathy, diabetic neuropathy and PAD. Participants underwent 24-h blood pressure monitoring and were analysed for markers of the metabolic syndrome, inflammation, and insulin resistance.Results57% of the participants had diabetic nephropathy, 46% had diabetic neuropathy while 26% had PAD. No significant association was found between RDW, diabetic neuropathy and PAD (p = NS). However, RDW was strongly associated with diabetic nephropathy (p = 0.006), even following adjustment for potential confounding variables. Multivariate logistic regression analysis showed RDW (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.15–2.35, p = 0.006), estimated glomerular filtration rate (OR 0.98, 95% CI 0.96–0.99, p < 0.001), night-time diastolic blood pressure (OR 1.07, 95% CI 1.03–1.11, p = 0.001) and erythrocyte sedimentation rate (OR 1.03, 95% CI 1.004–1.05, p = 0.019) to be independently associated with diabetic nephropathy.ConclusionsThis is the first study to report lack of association between RDW, neuropathy and PAD in subjects with type 2 diabetes mellitus. More importantly, RDW was shown to be significantly associated with diabetic nephropathy in a type 2 diabetic population with advanced proliferative retinopathy independent of traditional risk factors, including diabetes duration and glycaemic control.     

血常规检查对炎症性肠病活动性判断价值

目的 探讨血常规检查能否作为国人活动性炎症性肠病的评价方法.方法 112例炎症性肠病患者和58例健康人纳入研究.所有患者均进行血常规、C反应蛋白和血沉检测.克罗恩病和溃疡性结肠炎分别依据克罗恩病疾病活动指数和Truelove-witts标准进行疾病活动状态的评价.结果 活动期克罗恩病的血红蛋白、红细胞压积、平均血小板体积明显低于缓解期患者和健康对照,差异有统计学意义（P〈0.05）,而红细胞体积分布宽度、白细胞、中性粒细胞、血小板计数则高于缓解期和健康对照,差异有统计学意义（P〈0.05）.活动期溃疡性结肠炎的血红蛋白、红细胞压积、平均血小板体积亦显著低于缓解期和健康对照,差异有统计学意义（P〈0.05）,而血小板计数高于缓解期患者,差异有统计学意义（P〈0.05）,红细胞体积分布宽度、白细胞计数高于健康对照,差异有统计学意义（P〈0.05）.白细胞、血小板计数与血沉、C反应蛋白呈正相关性（P〈0.05）,而平均血小板体积与血沉、C反应蛋白呈负相关性（P〈0.05）.结论 血常规的多项指标随疾病活动状态改变而变化,并与目前公认的反应炎症指标呈明显相关性,提示血常规可以作为判断炎症性肠病活动度的方法.