红细胞分布宽度对原发性血小板增多症和真性红细胞增多症患者血栓形成及其预后的预测价值  

Value of red blood cell distribution width in predicting thrombosis and prognosis in essential thrombocythemia and polycythemia vera

作　　者：卢瑞 张梦潇 张爱边 汪英颖[1] 熊蓓[1] 刘亚楠 周怡[1] 左学兰[1] LU Rui;ZHANG Mengxiao;ZHANG Aibian;WANG Yingying;XIONG Bei;LIU Yanan;ZHOU Yi;ZUO Xuelan(Department of Hematology,Zhongnan Hospital of Wuhan University,Wuhan,430071,China)

机构地区：[1]武汉大学中南医院血液内科,武汉430071

出　　处：《临床血液学杂志》2021年第11期785-789,共5页Journal of Clinical Hematology

摘　　要：目的:探讨红细胞分布宽度(RDW)对原发性血小板增多症(ET)和真性红细胞增多症(PV)患者血栓形成及其预后的预测价值。方法:回顾性分析我院105例初诊骨髓增殖性肿瘤患者的临床资料,其中ET 65例,PV 40例,根据2016年WHO指南对ET和PV分别进行危险分层并分为低风险组及高风险组。分别比较ET和PV中两种组别的一般临床资料及实验室指标等相关因素;采用多因素Logistic回归法综合分析ET和PV患者预后不良的独立预测因素;绘制32例血栓形成患者的受试者工作特征(ROC)曲线,探讨RDW值对ET、PV患者血栓形成的预测作用;按最佳阈值分为高RDW组和低RDW组,采用Kaplan-Meier法分析两组的生存率。结果:65例ET患者中,极低/低风险25例,中/高风险40例;40例PV患者中,低风险13例,高风险27例。ET患者中低风险组和高风险组比较,年龄、体质性症状、血栓形成史、心血管危险因素、RDW、乳酸脱氢酶差异有统计学意义(P<0.05);PV患者中低风险组和高风险组比较,年龄、血栓形成史、RDW、D-二聚体差异有统计学意义(P<0.05)。多因素Logistic回归结果显示,年龄及RDW是预测ET、PV患者预后的独立危险因素(P<0.05)。RDW预测ET、PV患者血栓形成的ROC曲线下面积为0.805,最佳阈值为17.45%,灵敏度81.30%,特异度63.00%。Kaplan-Meier生存曲线提示,高RDW组累积生存时间明显短于低RDW组(P<0.05)。结论:RDW值对ET、PV患者血栓形成有预测价值,并且对其预后也有一定的预测价值,但仍需要大样本研究进一步证实。Objective: To investigate the value of red blood cell distribution width(RDW) in predicting thrombosis and prognosis in essential thrombocythemia(ET) and polycythemia vera(PV). Methods: The clinical data of 105 newly diagnosed patients with myeloproliferative neoplasms in our hospital were retrospectively analyzed, including 65 cases of ET and 40 cases of PV. They were divided into low-risk group and high-risk group according to WHO guidelines in 2016. The clinical characteristics and laboratory indicators of the two groups were compared. Multivariate Logistic regression was used to analyze the independent predictors of poor outcomes in ET and PV patients. The receiver operating characteristic(ROC) curve of 32 patients with thrombosis was drawn, and the role of RDW value in assessing the thrombosis in ET and PV patients was explored. According to the optimal threshold, it was divided into high RDW group and low RDW group, and Kaplan-Meier method was used to analyze the survival rate of the two groups. Results: Among the 65 ET patients, 25 cases were at very low/low risk and 40 cases were at medium/high risk. Of the 40 PV patients, 13 cases were at low risk and 27 cases were at high risk. There were significant differences in age, physical symptoms, thrombosis history, cardiovascular risk factors, RDW and LDH between the two groups of ET patients(P<0.05). And in PV patients, there were significant differences in age, thrombosis history, RDW and DD between the two groups(P<0.05). Multivariate Logistic regression analysis showed that age and RDW were independent risk factors for predicting the prognosis of ET and PV patients(P<0.05). The area under the ROC curve predicted by RDW for thrombosis in ET and PV patients was 0.805, the optimal threshold was 17.45%, the sensitivity was 81.30%, and the specificity was 63.00%. Kaplan-Meier survival analysis curve suggested that the survival rate of the high RDW group was lower than that of the low RDW group(P<0.05). Conclusion: RDW value has a predictive value on thrombosis

关 键 词：原发性血小板增多症 真性红细胞增多症 红细胞分布宽度 血栓形成 预后 

分 类 号：R7558.3[医药卫生—皮肤病学与性病学]