红细胞体积分布宽度在非ST段抬高急性冠状动脉综合征的临床应用

摘要

Objective To explore the predictive value of non-ST-segment elevation of acute coronary syndrome (NSTE-ACS)by detection of red blood cell volume distribution width(RDW)for determination of the cut off point.Methods From January2014 to June2015,146 NSTE-ACS cases were collected in observation group,and84 individuals were taken as control with non coronary heart disease confirmed by coronary angiography. The complete blood counting, cardiac troponin I(cTnI),and blood lipid wee tested.Results TC,LDL-C,cTnI,and RDW of NSTE-ACS group was higher than that of the control group,with a higher ratio of high blood pressure history or diabetes history(P<0.05). The RDW in those with the artery lesions of three branches was higher than with the single artery lesion and double branch lesions(P<0.05). RDW and cTnI were positively correlated(r=0.298,P<0.05). RDW receiver operating characteristic (ROC)curve analysis whowed thatthe best cut-off point of RDW for prediction of NSTE-ACS was11.93%,the area under the ROC curve was0.845(95% CI:0.792~0.898,P<0.05),specificity was82.90%,and sensitivity was72.62%. Patients with the RDW over11.93% presented a higher mortality or non-fatal myocardial infarction within30 days than those with the RDW below11.93%(P<0.05).Conclusion RDW is associated with the degree of lesion in NSTE-ACS, and may be used as auxiliary diagnosis and prognosis of NSTE-ACS.%目的：检测红细胞体积分布宽度（RDW），探讨RDW对非ST段抬高急性冠状动脉综合征（NSTE-ACS）的预测价值，找出预测界点。方法选取2014年1月~2015年6月的NSTE-ACS 146例，经冠状动脉造影术排除冠心病的84例作为对照组，检测血常规、心肌肌钙蛋白I（cTnI）、血脂。结果①NSTE-ACS组的TC、LDL-C、cTnI、RDW以及有高血压史、糖尿病史的比率高于对照组，差异有统计学意义，P<0.05。②NSTE-ACS组中3支病变组的RDW高于单支病变组、双支病变组，差异有统计学意义，P<0.05。③RDW与cTnI呈正相关，r=0.298，P<0.05。④经受试者工作特征（receiver operating characteristic，ROC）曲线分析，RDW预测NSTE-ACS的最佳界点为11.93%，ROC曲线下面积为0.845（95%CI：0.792~0.898，P<0.05），特异性为82.90%，敏感度为72.62%。⑤RDW大于11.93%的病例组在30 d内发生任何原因的死亡或非致死性心肌梗死的比例较RDW小于11.93%组高，差异有统计学意义，P<0.05。结论 RDW与NSTE-ACS病变程度有关，可作为预测NSTE-ACS以及预后辅助诊断的指标。