高红细胞分布宽度水平对动脉瘤性蛛网膜下腔出血不良预后的预测价值  

Prediction value of increased red cell distribution width for poor outcome in patients with aneurysmal subarachnoid hemorrhage

作　　者：陈刘炜 沈睿[1] 张翔[1] 徐一 卢昊 张全斌[1] 陈左权[1] Chen Liuwei;Shen Rui;Zhang Xiang;Xu Yi;Lu Hao;Zhang Quanbin;Chen Zuoquan(Department of Neurosurgery,Tenth People′s Hospital of Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院神经外科,上海200072

出　　处：《中国脑血管病杂志》2020年第4期174-180,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的 评估红细胞分布宽度(RDW)与动脉瘤性蛛网膜下腔出血(aSAH)患者功能预后的相关性.方法 回顾性纳入和分析2015年1月至2019年1月于同济大学附属第十人民医院接受治疗的262例aSAH患者的一般及临床资料.根据发病后3个月时改良Rankin量表(mRS)评分将患者分为预后良好(mRS评分≤2分)组及预后不良(mRS评分>2分)组,并进行组间各因素的单因素分析和多因素Logistic回归分析,分析RDW与aSAH患者预后的关系.采用受试者工作特征(ROC)曲线分析RDW在预测aSAH患者预后中的作用,并将截断值作为临界值对所有患者进行不同RDW水平的分组,分析两组患者间各因素的差异.结果 多因素Logistic回归分析结果显示,高水平RDW是aSAH患者功能预后不良的独立危险因子(OR=6.144,95%CI:2.641~14.296,P<0.01).ROC曲线分析表明,RDW预测功能预后的曲线下面积为0.829(95%CI:0.770~0.887,P<0.01).当截断值为12.25%,RDW≥12.25%时,RDW预测不良预后的敏感度为69.6%,特异度为80.3%.与入院时RDW<12,25%患者比较,入院时RDW水平较高(RDW≥12.25%)的患者,其Hunt-Hess分级较高,Fisher分级较高,急性脑积水、分流依赖性脑积水、迟发性脑缺血发生率较高,短期预后较差,病死率较高.结论 RDW是aSAH患者3个月不良预后的独立预测因子.Objective To assess whether red cell distribution width(RDW)is associated with functional outcome in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods We retrospectively collected and analyzed clinical data of patients with aSAH treated in our institution from January 2015 to January 2019.Patients were divided into two groups according to the modified Rankin Scale(mRS)score at 3 months.Univariate and multivariate logistic regression analyses were to determine whether RDW was associated with poor prognosis in patients with aSAH.The receiver operating characteristic(ROC)curve analysis was to indicate the value of RDW for the prediction of functional outcome in aSAH patients.Results A total of 262 patients were included in this study.Multivariate logistic regression analysis revealed that increased RDW was an independent predictor of poor functional outcome in patients with aSAH(odds ratio[OR]:6.144,95%confidence interval[CI]:2.641-14.296,P<0.01).ROC analysis revealed that RDW could predict the poor functional outcome at 3 months with an area under the curve of 0 829(95%CI:0.770-0.887,P<0.01).The cut off value,sensitivity,and specificity were 12.25%,69.6%,and 80.3%,respectively.Compared to those with the level of RDW less than 12.25%,Patients with the level of RDW more than 12.25%at admission tended to have higher Hunt Hess grades,higher Fisher grades,poorer outcomes,and higher mortality,as well as higher proportions of acute hydrocephalus,shunt dependent hydrocephalus and delayed cerebral ischemia.Conclusion RDW is an independent predictor of unfavorable functional outcome at 3 months in patients with aSAH.

关 键 词：红细胞分布宽度 动脉瘤性蛛网膜下腔出血 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]