红细胞分布宽度在肺癌转移中的应用价值

摘要

目的：探讨红细胞分布宽度（ RDW）在提示肺癌患者转移中的临床应用价值。方法回顾性分析上海市胸科医院2012年1月至2013年7月525例初诊肺癌患者的病历资料和全血RDW数据。对全部525例患者根据分期、有无转移等分组，并进一步对其中405例有转移者根据转移程度及其中246例有远端转移者根据远端转移器官数分别分组。多组间计量资料的比较用Kruskal-Wallis H检验，RDW与临床参数间的相关性用Spearman相关性分析。结果肺癌转移患者外周血RDW水平为14.5（13.0～15.4）％，显著高于未转移者[12.7（12.3～13.0）％]，差异有统计学意义（U＝8597.500，P＜0.05）。对于不同分期的肺癌患者，Ⅲ期、Ⅳ期组的 RDW[14.6（12.9～15.4）％]显著高于Ⅰ、Ⅱ期组[12.6（12.2～13.1）％]，差异有统计学意义（U＝8549.000，P＜0.05）。 RDW与分期、是否转移有一定相关性（r＝0.508、0.470，P均＜0.05）。 ROC曲线分析表明，RDW鉴别诊断肺癌是否发生转移、远端转移的曲线下面积（AUC）分别为0.823（95％ CI：0.787～0.859）和0.710（95％CI：0.655～0.765）。以Youden指数最大时的切点作为诊断肺癌转移的cut-off值（14.25％），此时敏感度为56.8％，特异度为98.3％，具有一定准确性。结论 RDW值的变化对判断肺癌患者转移情况有一定的应用价值。（中华检验医学杂志，2014，37：444-446）%Objective To investigate the clinical value of whole blood red cell distribution width ( RDW) in discriminating lung cancer metastasis.Methods A retrospective analysis was conducted on the patients who were initially diagnosed as primary lung cancer.A total of 525 patients were included for analysis between January 2012 and July 2013,stratified by different stages and metastasis scenarios.RDW data was investigated.Kruskal-Wallis H tests were performed to know the difference of RDW without and within groups.Spearman correlation test was done subsequently to further analyze the correlationship among RDW and clinical parameters.Results RDW was14.5 ( 13.0-15.4 )%in patients with metastasis , which was significantly higher than those without metastasis [12.7 (12.3-13.0)%].Further analysis indicated a similar ascending trend in cases that already had distant or multiple organ invasion.For example,RDW was 14.6 (12.9-15.4) %in patients of stage ⅢtoⅣ,while was 12.6 (12.2-13.1) %in patients of stageⅠtoⅡ.RDW was correlated to lung cancer metastasis and stage advancement.Areas Under Curve ( AUCs) of ROC for lung cancer metastasis and distant metastasis were 0.823 ( 95% CI:0.787-0.859 ) and 0.710 (95%CI:0.655-0.765) respectively,indicating a promising accuracy.The Cut-off value for discriminating lung cancer with/without metastasis was 14.25% with sensitivity being 56.8% and specificity being 98.3%.Conclusion RDW may be a novel biomarker for auxiliary diagnosis of lung cancer metastasis and could be useful to understand state of illness.