PDF(1108 KB)
红细胞分布宽度对脓毒症患儿急性肾损伤的预测价值
张林, 郭宽鹏, 莫宜, 易苏武, 黄彩芝, 隆彩霞, 莫丽亚
中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (7) : 559-562.
PDF(1108 KB)
PDF(1108 KB)
红细胞分布宽度对脓毒症患儿急性肾损伤的预测价值
Predictive value of red blood cell distribution width for acute kidney injury in children with sepsis
目的 初步探讨红细胞分布宽度（RDW）对脓毒症患儿急性肾损伤（AKI）的早期预测价值。方法 126例脓毒症患儿根据是否合并AKI分为AKI组（66例）及非AKI组（60例），另以RDW值的均数为界，分为高RDW组（58例）及低RDW组（68例）。比较各组年龄、性别比、体质指数（BMI）、急性生理和慢性健康评分（APACHE Ⅱ评分）、序贯器官衰竭估计评分（SOFA评分）、血清尿素氮（BUN）、肌酐（Cr）、尿酸（UA）、C反应蛋白（CRP）、血常规，并分析与RDW独立相关的因素。结果 AKI组与非AKI组在年龄、男女比例、BMI、CRP、SOFA评分、APACHE Ⅱ评分等方面的差异无统计学意义（P > 0.05），AKI组的血清BUN、Cr、UA、RDW高于非AKI组（P < 0.05）。高RDW组与低RDW组在年龄、男女比例、BMI等方面的差异无统计学意义（P > 0.05），但高RDW组的BUN、Cr、UA、CRP、SOFA评分、APACHE Ⅱ评分、血红蛋白、平均红细胞体积等较高（P < 0.05）。多元线性回归分析提示：与RDW独立相关的因素包括年龄、性别、APACHE Ⅱ评分、Cr、Hb、MCV。结论 脓毒症患儿红细胞分布宽度对于早期预测肾损伤具有一定的临床价值。
Objective To study the clinical value of red blood cell distribution width (RDW) in the early prediction of acute kidney injury (AKI) in children with sepsis.Methods A total of 126 children with sepsis were divided into an AKI group (n=66) and a non-AKI group (n=60) according to the presence or absence of AKI. These patients were also classifed into high-RDW and low-RDW groups according to the mean RDW. The groups were compared in terms of age, male-to-female ratio, body mass index (BMI), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Sequential Organ Failure Assessment (SOFA) score, serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), serum C-reactive protein (CRP), and routine blood test results. Independent factors associated with RDW were analyzed by multiple linear regression.Results Age, male-to-female ratio, BMI, CRP, SOFA score, and APACHE Ⅱ score did not differ signifcantly between the AKI and non-AKI groups (P > 0.05), but the AKI group had signifcantly higher BUN, Cr, UA, and RDW levels than the non-AKI group (P < 0.05). Age, male-to-female ratio, and BMI did not differ signifcantly between the high-RDW and low-RDW groups (P > 0.05), but the high-RDW group had signifcantly higher BUN, Cr, UA, CRP, SOFA score, APACHE Ⅱ score, Hb, and mean corpuscular volume (MCV) than the lowRDW group (P < 0.05). The multiple linear regression analysis showed that age, sex, APACHE Ⅱ score, Cr, Hb, and MCV were independent factors associated with RDW.Conclusions RDW has a certain clinical value in the early prediction of AKI in children with sepsis.
Sepsis / Red blood cell distribution width / Acute kidney injury / Child
[1] Fleischmann C, Thomas-Rueddel DO, Hartmann M, et al. Hospital incidence and mortality rates of sepsis[J]. Dtsch Arztebl Int, 2016, 113(10):159-166.
[2] Poukkanen M, Vaara ST, Pettilä V, et al. Acute kidney injury in patients with severe sepsis in Finnish intensive care units[J]. Acta Anaesthesiol Scand, 2013, 57(7):863-872.
[3] Li ZZ, Chen L, Yuan H,et al. Relationship between red blood cell distribution width and early-stage renal function damage in patients with essential hypertension[J]. J Hypertens, 2014, 32(12):2450-2455.
[4] Lippi G, Targher G, Montagnana M, et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients[J]. Scand J Clin Lab Invest, 2008, 68(8):745-748.
[5] 刘建峰, 华琦, 罗鸿宇, 等. 老年原发性高血压患者红细胞分布宽度与早期肾功能损害的相关性分析[J]. 中国心血管杂志, 2015, 20(4):256-261.
[6] Mahmood NA, Mathew J, Kang B, et al. Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis[J]. Int J Crit Illn Inj Sci, 2014, 4(4):278-282.
[7] 范金强, 范银强, 李振军. 红细胞体积分布宽度对脓毒症急性肾损伤患者预后的评估价值[J]. 海南医学, 2014, 25(20):3012-3014.
[8] Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Defnitions Conference[J]. Crit Care Med, 2003, 31(4):1250-1256.
[9] Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J]. Crit Care, 2004, 8(4):R204-R212.
[10] Lu JL, Molnar MZ, Naseer A, et al. Association of age and BMI with kidney function and mortality:a cohort study[J]. Lancet Diabetes Endocrinol, 2015, 3(9):704-714.
[11] Hoffmann JJ, Nabbe KC, van den Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV)[J]. Clin Chem Lab Med, 2015, 53(12):2015-2019.
[12] Lippi G, Salvagno GL, Guidi GC. Red blood cell distribution width is signifcantly associated with aging and gender[J]. Clin Chem Lab Med, 2014, 52(9):e197-e199.
[13] Souza AC, Volpini RA, Shimizu MH, et al. Erythropoietin prevents sepsis-related acute kidney injury in rats by inhibiting NF-κB and upregulating endothelial nitric oxide synthase[J]. Am J Physiol Renal Physiol, 2012, 302(8):F1045-F1054.
