红细胞分布宽度与非心源性缺血性卒中发病风险和严重程度的相关性

目的 探讨红细胞分布宽度(red blood cell distribution width,RDW)与非心源性缺血性卒中发病风险和严重程度的相关性.方法 回顾性纳入急性非心源性缺血性卒中患者作为病例组,同期在神经内科住院的非卒中患者作为对照组.采用美国国立卫生研究院卒中量表(NationalInstitutes of Health Stroke Scale,NIHSS)评定病例组基线神经功能缺损情况,＜8分定义为轻度卒中,≥8分定义为中重度卒中.收集并比较研究对象的人口统计学、临床资料和RDW,采用多变量logistic回归分析确定急性非心源性缺血性卒中的发病风险和卒中严重程度的独立危险因素,并采用受试者工作特征(receiver operator characteristic,ROC)曲线分析RDW对急性非心源性缺血性卒中及其病情严重程度的预测价值.结果 共纳入急性非心源性缺血性卒中患者1 173例,同期在神经内科住院的非卒中患者996例.病例组RDW显著高于对照组(13.1±1.0)％对(12.7±0.7)％;=9.545,P＜0.001].多变量logistic回归分析显示,RDW优势比(odds ratio,OR)9.920,95％可信区间(confidence interval,CI)6.286 ～ 15.655;P＜0.001]是急性非心源性缺血性卒中的独立危险因素.ROC曲线分析显示,RDW预测急性非心源性缺血性卒中的截断值为12.55％,ROC曲线下面积为0.611(95％ CI 0.588 ～0.635),敏感性为73.3％,特异性为43.7％,阳性预测值为60.5％,阴性预测值为58.2％,准确性为59.7％.中重度卒中亚组患者RDW显著高于轻度卒中亚组(13.7±1.6)％对(12.9±0.6)％;t-13.794,P＜0.001].多变量logistic回归分析显示,RDW(OR3.835,95％ CI3.002 ～4.899;P＜0.001)是急性非心源性缺血性卒中严重程度的独立危险因素.ROC曲线分析显示,RDW预测中重度非心源性脑梗死的截断值为13.45％,ROC曲线下面积为0.713(95％ CI0.674 ～0.752),敏感性为47.7％,特异性为86.1％,阳性预测值为49.8％,阴性预测值为85.1％,准确性为77.6％.结论 RDW是急性非心源性缺血性卒中的独立危险因素,其水平增高与急性非心源性缺血性卒中的病情严重程度相关.

Correlations of red blood cell distribution width with risk and severity of noncardiac ischemic stroke

Objective To investigate the correlation between the red blood cell distribution width (RDW) with risk and and severity of noncardiac ischemic stroke.Methods The patients with acute noncardiac ischemic stroke were enrolled retrospetively and were used as a case group,and the non-stroke patients admitted to the Department of Neurology at the same period were served as a control group.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the baseline neurological deficits.The NIHSS score ＜ 8 was defined as mild stroke and ≥ 8 was defined as moderate to severe stroke.The demographics,clinical data,and RDW were collected and compared.Multivariate logistic regression analysis was used to identify the independent risk factors for the risk of disease and severity of stroke in noncardiac ischemic stroke.Receiver operator characteristic (ROC) curve was used to analyze the predictive value of RDW for acute noncardiac ischemic stroke and its severity.Results A total of 1 173 patients with acute noncardiac ischemic stroke were enrolled.Over the same period,996 non-stroke patients were hospitalized in the Department of Neurology.The RDW in the case group was significantly higher than that in the control group (13.1％ ± 1.0％ vs.12.7％ ±0.7％;t=9.545,t ＜0.001).Multivariatelogistic regression analysis showed that RDW (odds ratio OR] 9.920,95％ confidence interval CI] 6.286-15.655,P＜ 0.001) was an independent risk factor for acute noncardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting acute noncardiac ischemic stroke was 12.55％,the area under the ROC curve was 0.611 (95％ CI 0.588-0.635),the sensitivity was 73.3％,the specificity was 43.7％,the positive predictive value was 60.5％,the negative predictive value was 58.2％,and the accuracy was 59.7％.RDW in the moderate to severe stroke subgroup was significantly higher than that in the mild stroke subgroup (13.7％ ± 1.6％ vs.12.9％ ± 0.6％,t =-13.794,P＜ 0.001).Multivariate logistic regression analysis showed that RDW (OR 3.835,95％ CI 3.002-4.899,P ＜ 0.001) was an independent risk factor for the severity of acute non-cardiac ischemic stroke.ROC curve analysis showed that the RDW cutoff value for predicting moderate to severe non-cardiac ischemic stroke was 13.45％,the area under the ROC curve was 0.713 (95％ CI 0.674-0.752),the sensitivity was 47.7％,the specificity was 86.1％,the positive predictive value was 49.8％,the negative predictive value was 85.1％,and the accuracy was 77.6％.Conclusions RDW is an independent risk factor for acute non-cardiac ischemic stroke.Increased RDW is associated with the severity of acute non-cardiac ischemic stroke.