红细胞分布宽度评估德尔塔变异株新冠病毒感染患者病情严重程度的价值  

Value of red blood cell distribution width in evaluating the severity of illness of novel coronavirus Delta variant

作　　者：申存毅[1] 邸莹[1] 王文静[1] 李希 薛玉龙 金玉峰 刘昌[1] Shen Cunyi;Di Ying;Wang Wenjing;Li Xi;Xue Yulong;Jin Yufeng;Liu Chang(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,陕西西安710061

出　　处：《中华危重病急救医学》2022年第5期475-480,共6页Chinese Critical Care Medicine

基　　金：国家临床重点专科建设项目(2012-650)。

摘　　要：目的探讨红细胞分布宽度(RDW)在评估德尔塔变异株新型冠状病毒(新冠病毒)感染患者病情严重程度中的价值。方法纳入2021年12月至2022年1月西安交通大学第一附属医院医疗队在新冠肺炎定点医院收治的28例德尔塔变异株新冠病毒感染患者(普通型23例、重型4例、危重型1例),收集患者临床资料,并通过相关性分析筛选出影响动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO_(2))的血液检查关键指标;按照红细胞分布宽度标准差(RDW-SD)中位值42.5 fL,将28例患者分为低RDW-SD组(≤42.5 fL,16例)和高RDW-SD组(>42.5 fL,12例),比较两组免疫相关指标;绘制受试者工作特征曲线(ROC曲线),评价RDW-SD对新冠肺炎患者严重程度的预测价值。结果相关性分析显示,在患者入院第1天实验室检查指标中,RDW-SD是唯一与PaO2和PaCO_(2)均相关的指标,并且与PaO2呈负相关(r=-0.379,P=0.047),与PaCO_(2)呈正相关(r=0.509,P=0.006)。进一步分析不同临床特征对RDW-SD水平的影响,结果显示,不同临床特征组之间RDW-SD数值(包括男性/女性、年龄≥65岁/<65岁、有/无高血压史、有/无糖尿病史、有/无吸烟史、有/无高热、有/无发热时间持续3 d、有/无呼吸系统症状、有/无消化系统症状)差异均无统计学意义,提示RDW-SD指标相对稳定,不受患者基线水平影响。低RDW-SD组CD19 B细胞比例明显高于高RDW-SD组(23.01±3.01比15.34±5.34,P<0.05),免疫球蛋白G(IgG)水平明显低于高RDW-SD组(g/L:11.43±3.20比15.42±1.54,P<0.05)。ROC曲线分析显示,RDW-SD评估新冠肺炎患者病情严重程度的ROC曲线下面积(AUC)为0.83〔95%可信区间(95%CI)为0.59~1.06〕,接近社区获得性肺炎常用评分标准预测病毒性肺炎死亡风险预测模型评分(MuL BSTA;AUC=0.82,95%CI为0.51~1.12),并优于英国胸科协会改良肺炎评分(CURB-65;AUC=0.70,95%CI为0.50~0.91)。结论RDW-SD对于评估德尔塔变异株新冠病毒感染患者的病情严重程�Objective To explore the value of red blood cell distribution width(RDW)in evaluating the severity of patients infected with novel coronavirus Delta variant.Methods A total of 28 patients infected with novel coronavirus Delta variant in designated hospital treated by the First Affiliated Hospital of Xi'an Jiaotong University medical team from December 2021 to January 2022 were enrolled(23 cases of common type,4 severe and 1 critical cases).The detailed clinical data of patients was collected.Then,Pearson's correlation analysis was used to identify the blood examination indexes which affected the arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO_(2)).According to the median standard deviation of red blood cell distribution width(RDW-SD,42.5 fL),28 patients were divided into low RDW-SD group(≤42.5 fL,16 cases)and high RDW-SD group(>42.5 fL,12 cases),and the immune related indexes of the two groups were compared.Receiver operator characteristic curve(ROC)was drawn to evaluate the predictive value of RDW-SD on the severity of illness of coronavirus disease 2019(COVID-19).Results Correlation analysis showed that RDW-SD was the only index related to PaO2 and PaCO_(2)on the first day of admission,which was negative correlation with PaO2(r=-0.379,P=0.047)and positive correlation with PaCO_(2)(r=0.509,P=0.006).The results of effects of different clinical characteristics on RDW-SD level showed that there was no statistically significant difference in RDW-SD between groups with different clinical characteristics(including male/female,≥65 years old/<65 years old,having/without hypertension,having/without diabetes,smoking/not smoking,having/without hyperpyrexia,with/without fever for 3 days,with/without respiratory symptoms,with/without digestive symptoms).It was suggested that RDW-SD be relatively stable and not affected by the patient's baseline level.The percentage of B cells in low RDW-SD group was higher than that in high RDW-SD group(23.01±3.01 vs.15.34±5.34,P<0.05),immu

关 键 词：红细胞分布宽度 新型冠状病毒肺炎 严重程度 

分 类 号：R563.1[医药卫生—呼吸系统]