红细胞分布宽度预测发热伴血小板减少综合征预后的临床价值  

Clinical value of red blood cell distribution width in predicting the prognosis of severe fever with thrombocytopenia syndrome

作　　者：彭蕾[1] 汤磊[1] 张振华[1] 邹桂舟[1] PENG Lei;TANG Lei;ZHANG Zhenghua;ZOU Guizhou(Department of Infectious Diseases,The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院感染病科,安徽合肥230601

出　　处：《安徽医药》2021年第3期500-503,共4页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省自然科学基金(1608085MH162)。

摘　　要：目的探讨红细胞分布宽度(RDW)对发热伴血小板减少综合征预后的预测价值。方法回顾性分析2016年6月至2019年6月安徽医科大学第二附属医院救治的发热伴血小板减少综合征病人95例(治疗组),以及同期医院健康体检者60例(健康组)。治疗组95例病人根据临床预后分为存活组81例和死亡组14例。收集病人入院当天(基线)、治疗后第3天血常规中白细胞、中性粒细胞、淋巴细胞、单核细胞、RDW、血小板计数等指标,计算中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)、△RDW3(治疗后第3天RDW-入院当天RDW),以此类推计算△NLR3、△PLR3、△LMR3,比较存活组和死亡组上述指标的差异。应用t检验、Mann-Whitney U检验、logistic回归分析探讨影响疾病预后的因素。结果治疗组基线白细胞、中性粒细胞、淋巴细胞、单核细胞、RDW、血小板计数,NLR、PLR、LMR与健康对照组比较,均差异有统计学意义(P<0.05)。存活组基线RDW、治疗后第3天RDW、△RDW3分别为42.80(40.75,45.40)、(43.57±3.54)和(0.45±1.90),较死亡组的45.90(44.65,47.60)、(47.60±1.23)和(2.50±2.60),均差异有统计学意义(P<0.01)。多因素logistic回归分析提示△RDW3是影响疾病预后的主要因素,根据约登指数原则提示△RDW3预测死亡风险的临界值为2.15,即△RDW3>2.15时新型布尼亚病毒感染病人病死率较高。结论动态监测RDW,△RDW3可预测发热伴血小板减少综合征的病情和预后;△RDW3是影响病人预后的独立危险因素。Objective To investigate the clinical value of red blood cell distribution width(RDW)in predicting the prognosis of pa⁃tients with severe fever with thrombocytopenia syndrome(SFTS).Methods 95 SFTS patients admitted in the Second Hospital of Anhui Medical University from June 2016 to June 2019(treatment group)and 60 cases of healthy physical examiners at the same period(healthy control group)were retrospectively analysed.The treatment group were divided into survival group(81 patients)and death group(14 patients)according to the clinical prognosis.Indicators including white blood cells,neutrophil,lymphocyte,monocytes,red blood cell distribution width(RDW),platelet,were collected at day 1,day 3 of admission.Calculated neutrophil to·lymphocyte ratio(NLR),platelet to 1ymphocyte ratio(PLR),1ymphocyte-to-monocyte ratio(LMR),△RDW3(day 3 of admission RDW-on day 1 of admission RDW),cal⁃culating△NLR3,△PLR3,△LMR3 and so on.Comparing the differences of the above indicators between the survival group and death group.The t-test,Mann Whitney U-test and logistic regression analysis were used to identify independent risk factors affecting prognosis in these patients.Results The baseline white blood cells,neutrophil,lymphocyte,monocytes,red blood cell distribution width,platelet,NLR,PLR and LMR were all statistically different between in the treatment group and the healthy control group(P<0.05).Baseline RDW,day 3 RDW,△RDW3 in the survival group were 42.80(40.75,45.40),43.57(3.54)and 0.45(1.90),respectively,compared with the death group 45.90(44.65,47.60),47.60(1.23)and 2.50(2.60),with statistically significant differences(P<0.01).Multivariate 1ogistic regression analysis indicates that△RDW3 was the main factor affecting the prognosis of the SFTS.According to the principle of Youden index,the cut off value of△RDW3 to predict the death risk of SFTS was 2.15.The mortality was higher when△RDW3 was higher than 2.15.Con⁃clusion Dynamic monitoring of RDW,△RDW3 may predict the condition and prognosis of SFTS;△RD

关 键 词：布尼亚病毒科感染 发热伴血小板减少综合征(SFTS) 红细胞分布宽度(RDW) 中性粒细胞减少 淋巴细胞 单核细胞 预后 

分 类 号：R512.8[医药卫生—内科学]