CAJ | 학술논문

目的探讨脓毒症患者28 d预后与红细胞分布宽度(RDW)的相关性.方法采用前瞻性观察性研究的方法.连续性选择213例脓毒症患者,根据RDW将患者分为两组:正常RDW组(RDW＜ 0.15,160例)和高RDW组(RDW≥0.15,53例),比较两组患者的一般情况、急性生理学和慢性健康状况(APACHE)Ⅱ评分、序贯器官衰竭评分(SOFA)、高敏C反应蛋白(hs-CRP)、降钙素原(PCT)、动脉血乳酸、肝功能损伤、肾功能损伤及28 d病死率等;采用多因素Logistic回归分析影响28d预后的独立危险因素;采用Kaplan-Meier生存分析,按RDW分层,绘制28 d生存曲线,采用log-rank检验比较两组累计生存率.结果高RDW组28 d病死率显著高于正常RDW组[35.8％(19/53)比17.5％(28/160)],差异有统计学意义(P=0.007).RDW≥0.15是脓毒症患者28 d死亡的独立危险因素(OR=2.634,95％ CI 1.316 ～ 5.273,P=0.006),在校正性别、年龄及其他相关因素后,RDW≥0.15仍是脓毒症患者28 d死亡的独立危险因素(OR=2.895,95％CI1.155 ～7.252,P=0.023).高RDW组28 d累计生存率显著低于正常RDW组(50.5％比63.0％),差异有统计学意义(P=0.014).结论脓毒症患者RDW高于正常是其28 d死亡的独立危险因素,RDW≥0.15对28d预后评估有重要参考价值.
목적 탐토농독증환자28 d예후여홍세포분포관도(RDW)적상관성.방법 채용전첨성관찰성연구적방법.련속성선택213례농독증환자,근거RDW장환자분위량조:정상RDW조(RDW＜ 0.15,160례)화고RDW조(RDW≥0.15,53례),비교량조환자적일반정황、급성생이학화만성건강상황(APACHE)Ⅱ평분、서관기관쇠갈평분(SOFA)、고민C반응단백(hs-CRP)、강개소원(PCT)、동맥혈유산、간공능손상、신공능손상급28 d병사솔등;채용다인소Logistic회귀분석영향28d예후적독립위험인소;채용Kaplan-Meier생존분석,안RDW분층,회제28 d생존곡선,채용log-rank검험비교량조루계생존솔.결과 고RDW조28 d병사솔현저고우정상RDW조[35.8％(19/53)비17.5％(28/160)],차이유통계학의의(P=0.007).RDW≥0.15시농독증환자28 d사망적독립위험인소(OR=2.634,95％ CI 1.316 ～ 5.273,P=0.006),재교정성별、년령급기타상관인소후,RDW≥0.15잉시농독증환자28 d사망적독립위험인소(OR=2.895,95％CI1.155 ～7.252,P=0.023).고RDW조28 d루계생존솔현저저우정상RDW조(50.5％비63.0％),차이유통계학의의(P=0.014).결론 농독증환자RDW고우정상시기28 d사망적독립위험인소,RDW≥0.15대28d예후평고유중요삼고개치.
Objective To investigate the correlation between 28-day prognosis and red cell distribution width (RDW) in sepsis patients.Methods This was a prospective observational study.Two hundred and thirteen sepsis patients were consecutively selected,and the patients were divided into 2 groups according to RDW:normal RDW group (RDW ＜ 0.15,160 cases) and high RDW group (RDW≥0.15,53 cases).The general conditions,acute physiology and chronic health evaluation (APACHE) 1Ⅱ score,sequential organ failure assessment (SOFA),hypersensitive C reactive protein (hs-CRP),procalcitonin (PCT),arterial blood lactic acid,liver function injury,renal function injury and 28-day mortality were compared between 2 groups.The independent risk factors of 28-day prognosis were analyzed by multifactor Logistic regression analysis.Kaplan-Meier survival analysis was used to draw the 28-day survival curve,and the survival rate was compared between 2 groups by log-rank test.Results The 28-day mortality in high RDW group (35.8％,19/53) was significantly higher than that in normal RDW group (17.5％,28/160),and there was statistical difference (P =0.007).RDW ≥0.15 was the independent risk factor of 28-day death in sepsis patients (OR =2.634,95％ CI 1.316-5.273,P =0.006).After adjusted by gender,age and other relative factors,RDW≥0.15 was the independent risk factor of 28-day death in sepsis patients (OR =2.895,95％ CI 1.155-7.252,P =0.023).The 28-day accumulative survival rate in high RDW group was significantly lower than that in normal RDW group (50.5％ vs.63.0％),and there was statistical difference (P =0.014).Conclusion The high RDW in sepsis patients is the independent risk factor of 28-day death,and RDW ≥0.15 shows an important predictive value in the prognosis of sepsis patients.