目的：探讨红细胞分布宽度（RDW）对非 ST 段抬高型急性冠脉综合征（NSTE-ACS）患者预后的预测价值及其影响因素。方法选取2014年1月—2016年1月武汉大学人民医院收治的NSTE-ACS患者285例，按疾病类型分为不稳定型心绞痛（ UAP）组135例和非 ST 段抬高型心肌梗死（ NSTEMI）组150例；按 RDW 中位数（13.88%）分为低 RDW 组（﹤13.88%）142例和高 RDW 组（≥13.88%）143例。分别比较 UAP 组与 NSTEMI 组、低 RDW 组与高 RDW 组患者的临床资料，分析 NSTEMI 的影响因素及 RDW 对 NSTEMI 的预测价值。结果 UAP 组与NSTEMI 组患者高血压和糖尿病发生率、年龄、血小板计数（PLT）、平均血小板体积（MPV）、尿素氮（BUN）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）比较，差异无统计学意义（ P ﹥0.05）；NSTEMI 组患者男性所占比例、吸烟史阳性率、白细胞计数（WBC）、中性粒细胞计数（NEUT）、红细胞计数（RBC）、血红蛋白（Hb）、RDW、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（ AST）、总胆固醇（ TC）、低密度脂蛋白胆固醇（ LDL-C）、空腹血糖（FPG）、尿酸（UA）、肌酐（Cr）、肌钙蛋白 I（cTnI）、Gensini 积分高于 UAP 组，冠状动脉病变支数多于 UAP 组，左心室射血分数（ LVEF）低于 UAP 组（ P ﹤0.05）。多因素 logistic 回归分析结果显示，NEUT〔 OR =1.514，95% CI （1.188，1.928）〕、RDW〔OR =2.732，95% CI（1.887，3.954）〕为 NSTEMI 的危险因素（P ﹤0.05），LVEF〔OR =0.433，95% CI（0.330，0.569）〕为 NSTEMI 的保护因素（P ﹤0.05）。低 RDW 组与高 RDW 组患者男性所占比例、高血压和糖尿病发生率、吸烟史阳性率、年龄、RBC、Hb、PLT、MVP、BUN、TG、FPG、UA、Cr 比较，差异无统计学意义（P ﹥0.05）；高 RDW 组患者 UAP 发生率、LVEF 低于低 RDW 组，NSTEMI 发生率、WBC、NEUT、ALT、AST、TC、HDL-C、LDL-C、cTnI、Gensini 积分高于低 RDW 组，冠状动脉病变支数多于低 RWD 组（P ﹤0.05）。Pearson 相关性分析结果显示，RDW 与 cTnI 呈正相关（r =0.552，P ﹤0.001）。RDW 预测NSTE-ACS患者 NSTEMI 的 ROC 曲线下面积为0.687〔95% CI（0.626，0.747）〕，RDW 为13.5%时其灵敏度为62.0%，特异度为63.0%，诊断指数为0.687。结论 RDW 可早期预测NSTE-ACS患者 NSTEMI 的发生，而 NEUT、RDW 为 NSTEMI 的危险因素，LVEF 为 NSTEMI 的保护因素。%Objective To investigate the predictive value of red blood cell distribution width(RDW)on prognosis of patients with non ST - segment elevation acute coronary syndrome(NSTE-ACS)and the influencing factors. Methods A total of 285 patients with NSTE-ACS were selected in the People's Hospital of Wuhan University from January 2014 to January 2016, and they were divided into A group( with unstable angina pectoris,n = 135) and B group〔 with non ST - segment elevation myocardial infarction(NSTEMI),n = 150〕according to disease type,into C group(with lower RDW,n = 142)and D group (with higher RDW,n = 143)according to the median of RDW(13. 88% ). Clinical data was compared between A group and B group,between C group and D group,influencing factors of NSTEMI and the predictive value of RDW on NSTEMI were analyzed. Results No statistically significant differences of incidence of hypertension or diabetes,age,PLT,MPV,BUN, TG or HDL-C was found between A group and B group(P ﹥ 0. 05);the proportion of male,positive rate of smoking history, WBC,NEUT,RBC,Hb,RDW,ALT,AST,TC,LDL-C,FPG,UA,Cr,cTnI and Gensini score of B group were statistically significantly higher than those of A group,the number of stenosed coronary vessels of B group was more than that of A group,while LVEF of B group was statistically significantly lower than that of A group( P ﹤ 0. 05). Multivariate logistic regression analysis showed that,NEUT〔 OR = 1. 514,95% CI ( 1. 188,1. 928 )〕 and RDW 〔 OR = 2. 732,95% CI (1. 887,3. 954)〕were risk factors of NSTEMI in patients with NSTE-ACS,while LVEF〔 OR = 0. 433,95% CI(0. 330, 0. 569)〕 was the protective factor( P ﹤ 0. 05). No statistically significant differences of proportion of male,incidence of hypertension or diabetes,positive rate of smoking history,age,RBC,Hb,PLT,MVP,BUN,TG,FPG,UA or Cr was found between C group and D group( P ﹥ 0. 05);the incidence of unstable angina pectoris and LVEF of D group were statistically significantly lower than those of C group,the incidence of NSTEMI,WBC,NEUT,ALT,AST,TC,HDL-C, LDL-C,cTnI and Gensini score of D group were statistically significantly higher than those of C group,while the number of stenosed coronary vessels of D group was statistically significantly more than that of C group( P ﹤ 0. 05). Pearson correlation analysis showed that,RDW was negatively correlated with cTnI( r = 0. 552,P ﹤ 0. 001). The AUC of ROC of RDW in predicting NSTEMI was 0. 687 〔 95% CI( 0. 626,0. 747 )〕 in patients with NSTE-ACS,when RDW was 13. 5% ,the sensitivity was 62. 0% ,the specificity was 63. 0% ,the diagnosis index was 0. 687. Conclusion RDW can early predict the occurrence of NSTEMI in patients with NSTE-ACS;NEUT and RDW were risk factors of NSTEMI in patients with NSTE-ACS, while LVEF was the protective factor.
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