CAJ | 학술논문

目的：探讨老年脑梗死严重偏瘫患者急性期的红细胞分布宽度（RDW）与院内预后的相关性。方法回顾性连续纳入2012年1月至2013年12月就诊于上海市嘉定区中心医院急诊科的老年脑梗死严重偏瘫患者209例，根据RDW三位数水平将所有患者分为L-RDW组（73例）、M-RDW组（56例）和H-RDW组（80例）。单因素方差分析比较3组患者住院期间的临床资料、实验室指标及病死率的差异性。根据临床转归再将患者分为存活组（170例）和病死组（39例），比较其急性期RDW水平的差异性。采用Logistic回归分析方法分析患者死亡的独立危险因素，并计算风险比（OR）；采用Spearman相关分析对RDW与美国国立卫生研究院卒中量表（NIHSS）评分进行相关分析。结果 M-RDW组的病死率显著低于L-RDW组及H-RDW组[分别为1.8％（1例）、12.3％（9例）、36.2％（29例），均 P＜0.01）]；病死组患者的 RDW水平显著高于存活组[中位数14.2（13.3，15.1）比12.5（11.9，13.5），P＝0.002]。高RDW水平（OR＝12.164，95％CI：2．544～58．181，P ＝0.002）及 NIHSS评分（OR ＝1.136，95％CI：1.056～1．221；OR ＝1.229，P ＝0.001）是老年脑梗死严重偏瘫患者死亡的独立危险因素；RDW水平与NIHSS评分呈正相关（r＝0.167，P＝0.016）。结论老年脑梗死严重偏瘫患者不同RDW水平的病死率呈“U”形，高水平RDW的病死率最高。RDW水平对判断老年脑梗死严重偏瘫患者预后有重要参考价值。
목적：탐토노년뇌경사엄중편탄환자급성기적홍세포분포관도（RDW）여원내예후적상관성。방법회고성련속납입2012년1월지2013년12월취진우상해시가정구중심의원급진과적노년뇌경사엄중편탄환자209례，근거RDW삼위수수평장소유환자분위L-RDW조（73례）、M-RDW조（56례）화H-RDW조（80례）。단인소방차분석비교3조환자주원기간적림상자료、실험실지표급병사솔적차이성。근거림상전귀재장환자분위존활조（170례）화병사조（39례），비교기급성기RDW수평적차이성。채용Logistic회귀분석방법분석환자사망적독립위험인소，병계산풍험비（OR）；채용Spearman상관분석대RDW여미국국립위생연구원졸중량표（NIHSS）평분진행상관분석。결과 M-RDW조적병사솔현저저우L-RDW조급H-RDW조[분별위1.8％（1례）、12.3％（9례）、36.2％（29례），균 P＜0.01）]；병사조환자적 RDW수평현저고우존활조[중위수14.2（13.3，15.1）비12.5（11.9，13.5），P＝0.002]。고RDW수평（OR＝12.164，95％CI：2．544～58．181，P ＝0.002）급 NIHSS평분（OR ＝1.136，95％CI：1.056～1．221；OR ＝1.229，P ＝0.001）시노년뇌경사엄중편탄환자사망적독립위험인소；RDW수평여NIHSS평분정정상관（r＝0.167，P＝0.016）。결론노년뇌경사엄중편탄환자불동RDW수평적병사솔정“U”형，고수평RDW적병사솔최고。RDW수평대판단노년뇌경사엄중편탄환자예후유중요삼고개치。
Objective Toinvestigatethecorrelationbetweentheredbloodcelldistributionwidth (RDW)and in-hospital prognosis in elderly patients with cerebral infarction and severe hemiplegia. Methods Atotalof209consecutiveelderlypatientswithcerebralinfarctionandhemiplegiadiagnosedat the Emergency Department,Central Hospital of Jiading District in Shanghai from January 2012 to December 2013 were enrolled retrospectively. All patients were divided into an L-RDW group (n=73 ),an M-RDW group (n=56),and an H-RDW group (n=80)according to the RDW trisection level. A single factor analysis of variance was used to compare the differences of clinical data,laboratory indexes,and mortality during hospitalization among the three groups. The patients were redivided into either a survival group (n=170)or a death group (n=39)according to their clinical outcomes. Its differences of RDW levels in the acute phase were compared. Logistic regression analysis was used to analyze the independence risk factors for the death of patients,and the risk ratio (OR)was calculated. Spearman correlation analysis was used to analyzeRDWandtheNationalInstitutesofHealthStrokeScale(NIHSS)scores.Results Themortality of the M-RDW group was significantly lower than that of the L-RDW and the H-RDW groups (1. 8%[n=1] vs. 12. 3%[n=9]and 36. 2%[n=29],all P<0. 01). the RDW level of the death group was significantly higher than that of the survival group (14.2 [13.3,15.1]vs.12.5 [11. 9,13. 5];P =0. 002). The H-RDW level (OR,12. 164,95%CI 2.544-58.181,P=0.002)and the NIHSS score (OR,1. 136, 95%CI 1. 056-1. 221,P=0. 001)were the independence risk factors for the death of the elderly patients with severe hemiplegia cerebral infarction;the RDW level was positively correlated with the NIHSSscore(r=0.167,P=0.016).Conclusion ThemortalityofdifferentRDWlevelsinelderly patients with cerebral infarction and severe hemiplegia showed a"U" shape. The mortality of the H-RDW is the highest. The RDW level has an important reference value for identifying the prognosis in elderly patients with cerebral infarction and severe hemiplegia.