作者：张丹，亓磊，陈彦路，叶军

单位：

435000湖北省黄石市，黄石爱康医院呼吸内科

单位（英文）：

Department of Respiratory, Huangshi Love & Health Hospital, Huangshi 435000, China

关键词：

肺疾病，慢性阻塞性；红细胞分布宽度；再入院

关键词（英文）：

Pulmonary disease, chronic obstructive; Red cell distribution width; Readmission

中图分类号：

R 563.9

DOI：

10.12114/j.issn.1008-5971.2023.00.230

基金项目：

湖北省卫生健康委第三批联合基金立项项目（WJ2019H476）

摘要：

目的　探讨红细胞分布宽度（RDW）动态变化对慢性阻塞性肺疾病急性加重期（AECOPD）患者出 院后30 d内再入院的预测价值。方法　选取2019年10月至2022年5月黄石爱康医院收治的AECOPD患者210例。其中40 例患者因AECOPD再入院，将其作为再入院组，其余患者作为非再入院组。比较两组临床资料〔性别、年龄、BMI、 病程、过去1年内急性加重次数、吸烟史、基础疾病（高血压、糖尿病、冠心病）、机械通气使用情况、出院后应 用糖皮质激素情况、慢性阻塞性肺疾病评估测试（CAT）评分、住院时间〕、实验室检查指标〔血红蛋白（Hb）、 WBC、中性粒细胞与淋巴细胞比值（NLR）、pH值、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、血 氧饱和度（SaO2）、呼气流量峰值（PEF）、第1秒用力呼气容积占预计值百分比（FEV1%pred）、第1秒用力呼气容 积/用力肺活量（FEV1/FVC）、最大呼气中期流量（MMEF）〕、ΔRDW、RDW变异率。采用多因素Logistic回归分析 探讨AECOPD患者出院后30 d内再入院的影响因素。采用ROC曲线分析RDW变异率对AECOPD患者出院后30 d内再入 院的预测价值。结果　再入院组BMI、FEV1%pred低于非再入院组，出院后应用糖皮质激素者占比、CAT评分、NLR、 ΔRDW、RDW变异率高于非再入院组（P＜0.05）。多因素Logistic回归分析结果显示，RDW变异率升高是AECOPD患 者出院后30 d内再入院的独立危险因素（P＜0.05）。ROC曲线分析结果显示，RDW变异率预测AECOPD患者出院后 30 d内再入院的AUC为0.927〔95%CI（0.901，0.977）〕，最佳截断值为-1.71%，灵敏度为87.5%，特异度为92.4%。 结论　RDW变异率对AECOPD患者出院后30 d内再入院具有较高的预测价值。

英文摘要：

Objective To explore the predictive value of dynamic changes of red cell distribution width (RDW) for readmission in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) within 30 days after discharge. Methods A total of 210 patients with AECOPD admitted to Huangshi Love & Health Hospital from October 2019 to May 2022 were selected. Among them, 40 patients were readmitted due to AECOPD and were as the readmission group, while the rest patients were as the non readmission group. The clinical data [gender, age, BMI, duration of disease, number of acute exacerbations in the past 1 year, smoking history, underlying disease (hypertension, diabetes, coronary heart disease) , use of mechanical ventilation, use of glucocorticoids after discharge, COPD Assessment Test (CAT) score, length of stay] , laboratory test indexes [hemoglobin (Hb) , WBC, neutrophil to lymphocyte ratio (NLR) , pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2) , oxygen saturation of blood (SaO2) , peak expiratory flow rate (PEF) , forced expiratory volume in one second in percent predicted values (FEV1%pred) , forced expiratory volume in one second/forced vital capacity (FEV1/FVC) , maximal mid-expiratory flow curve (MMEF) ] , ΔRDW and RDW variation rate were compared between the two groups. Multivariate Logistic regression analysis was used to investigate the influencing factors of readmission in patients with AECOPD within 30 days after discharge. ROC curve was used to investigate the predictive value of RDW variation rate for readmission in AECOPD patients within 30 days after discharge. Results The BMI and FEV1%pred of the readmission group were lower than those of the non readmission group, and the proportion of patients receiving glucocorticoids after discharge,

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