Predictive Value of RDW and Blood Lipid on Gastroesophageal Variceal Bleeding in Patients with Liver Cirrhosis
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摘要:
目的 探讨红细胞分布宽度（red cell distribution width, RDW）及血脂与肝硬化伴食管胃底静脉曲张破裂出血（gastroesophageal variceal bleeding, GEVB）的相关性及临床价值。 方法 以昆明市第三人民医院肝病综合科2021年1月至2021年5月期间收治住院的发生GEVB的肝硬化患者60例为出血组，随机选取同期住院的未发生GEVB的肝硬化患者60例为未出血组。对比分析2组患者的基本资料、RDW、PLT、肝功能生化指标和血脂相关指标，然后通过多因素二元Logistic回归分析探索RDW和血脂对GEVB的影响，最后用ROC曲线判断其诊断效能。 结果 与未出血组相比，出血组RDW升高，TG、TC、HDL-C、LDL-C、ApoA1、ApoE降低（均P < 0.05）。二元Logistic回归分析提示，RDW是肝硬化患者发生GEVB的独立危险因素（OR = 1.367, 95%CI：1.141～1.639），TC是肝硬化患者发生GEVB的独立保护因素（OR = 0.437, 95%CI: 0.262～0.728）（均P < 0.05）。通过绘制ROC曲线提示，RDW诊断GEVB的曲线下面积（AUC）为0.803（P < 0.05），最佳临界值15.25%，敏感度为86.7%、特异性为63.3%；TC诊断GEVB的AUC为0.789（P < 0.05），最佳临界值2.765 mmol/L，敏感度为78.3%、特异性为75.0%。 结论 RDW及TC对于肝硬化患者发生GEVB具有较高的判断价值，临床需高度重视。 -
关键词:
- 肝硬化 /
- 食管胃底静脉曲张破裂出血 /
- 红细胞分布宽度 /
- 血脂
Abstract:Objective To explore the correlation between the red blood cell distribution width （RDW） / lipids and gastroesophageal variceal bleeding （GEVB） in patients with liver cirrhosis. Methods A total of 60 GEVB patients admitted to the Comprehensive Hepatology Department of the Third People’s Hospital of Kunming from January, 2021 to May, 2021 were assigned to the bleeding group, meanwhile, another 60 liver cirrhosis patients without GEVB were randomly selected as the non-bleeding group. The basic data, RDW, PLT, biochemical indexes of liver function and blood lipid related indexes of the two groups were compared, and then the effects of RDW and blood lipid on GEVB were explored through multivariate binary logistic regression analysis. Finally, ROC curves were used to assess the diagnostic effectiveness. Results Compared with the non-bleeding group, RDW in the bleeding group increased significantly, while TG, TC, HDL-C, LDL-C, ApoA1 and ApoE decreased significantly （all P < 0.05）. Binary logistic regression analysis showed that RDW was an independent risk factor （OR = 1.367, 95%CI: 1.141～1.639） while TC was the protective factor （OR = 0.437, 95%CI: 0.262～0.728） for GEVB in patients with liver cirrhosis （all P < 0.05）. For RDW, the area under curve （AUC） of ROC was 0.803 （P < 0.05）, optimum threshold was 15.25%, sensitivity and specificity were 86.7% and 63.3%, respectively; and for TC, AUC of ROC was 0.789 （P < 0.05）, optimum threshold was 2.765 mmol/L and the sensitivity and specificity were 78.3% and 75.0%, respectively. Conclusion RDW and TC have the high value in the diagnosis of GEVB in patients with liver cirrhosis, to which intensive attention should be paid clinically. -
图 1 RDW和TC诊断肝硬化伴GEVB的ROC曲线
Figure 1. ROC curve of RDW and TC in the diagnosis of liver cirrhosis with GEVB
表 1 出血组与未出血组基本资料比较[
$\bar x \pm s$ /n（%）/M（P25，P75）]Table 1. Comparison of basic data between bleeding group and non bleeding group[
$\bar x \pm s$ /n（%）/M（P25，P75）]项目 出血组（n=60） 未出血组（n=60） χ2/t/U P 年龄（岁） 48.75 ± 8.75 51.73 ± 1.733 −1.674 0.097 性别 44/16 39/21 0.977a 0.323 男性 44 （73.33） 39 （65.00） 女性 16 （26.67） 21 （35.00） 吸烟 30（50.00） 32（53.33） 0.133a 0.715 饮酒 28（46.67） 24（40.00） 0.543a 0.461 RDW （%） 18.15（15.93～19.9） 14.45（13.43～16.6） 708.00 < 0.001* PLT （×109/L） 73.00（65.25～98.00） 73.00（52.00～95.50） 1795.50 0.981 TBIL （μmol/L） 26.00（16.90～40.98） 30.65（20.93～64.43） 144.05 0.059 AST （U/L） 43.00（27.25～73.50） 42.50（29.00～74.25） 1684.50 0.544 ALT （U/L） 28.50（17.25～50.25） 32.00（22.00～53.00） 1632.00 0.378 ALB （g/L） 29.25（23.38～34.00） 34.30（27.13～41.63） 1172.50 0.001* CHE （U/L） 2387.50（2014.25～3573） 4162.50（2546.75～6096.00） 950.50 < 0.001* TG （mmol/L） 0.66（0.49～0.93） 0.81（0.54～1.26） 1408.00 0.040* TC （mmol/L） 2.40（1.67～2.77） 3.34（2.8～4.23） 758.00 < 0.001* HDL-C （mmol/L） 0.65（0.46～0.92） 1.07（0.79～1.35） 976.50 < 0.001* LDL-C （mmol/L） 1.40 ± 0.54 1.92 ± 0.70 −4.531 < 0.001* ApoA1 （g/L） 0.82 ± 0.26 1.11 ± 0.47 −4.234 < 0.001* ApoE （mg/L） 37.75（29.35～45.8） 42.6（30.85～78.55） 1356.50 0.020* *P < 0.05。 
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表 2 肝硬化伴GEVB的相关因素分析
Table 2. Analysis of related factors of liver cirrhosis with GEVB
自变量 B S.E. Wald DF P OR OR的95% CI 下限 上限 RDW (%) 0.313 0.092 11.463 1 0.001* 1.367 1.141 1.639 TC(mmol/L) −0.828 0.260 10.128 1 0.001* 0.437 0.262 0.728 *P < 0.05。
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