红细胞分布宽度：短暂性脑缺血发作后卒中风险的新型预测生物标志物。
Red cell distribution width: a novel predictive biomarker for stroke risk after transient ischaemic attack.
机构信息
Department of Neurology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, China.
Department of Nephrology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China.
出版信息
Ann Med. 2022 Dec;54(1):1167-1177. doi: 10.1080/07853890.2022.2059558.
OBJECTIVE
Predicting the prognosis of transient ischaemic attack (TIA) is difficult for many frontline clinicians. The purpose of this study was to determine whether subsequent stroke in TIA patients can be predicted via red blood cell distribution width (RDW).
MATERIAL AND METHODS
A total of 360 consecutive patients with new-onset TIA in our stroke centre, were enrolled over the period studied. The patients were divided into three groups: 103 TIA patients, 206 ischaemic stroke (IS) patients and 51 patients with haemorrhagic stroke (HS) within 7 days after TIA. Complete blood count, biochemical parameters and brain imaging were performed on all patients.
RESULTS
The mean RDW values of patients with IS and HS after TIA were significantly higher than patients with TIA (13.35 ± 1.59 vs 12.84 ± 1.19, 13.32 ± 1.08 vs 12.84 ± 1.19, respectively, all ≤ .001). In a multivariate model, RDW was independently associated with stroke after TIA (IS: odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.46-3.35, = .002; HS: OR = 1.511, 95% CI = 1.101-2.074, = .011). Compared to ABCD scores, the diagnostic power of RDW in the differentiation of patients with IS after TIA was better (area under curve (AUC): 0.731 vs 0.613, = .015). When an RDW cut-off value of 13.95% was accepted for differentiating patients with IS from TIA, the sensitivity and specificity were 73.7% and 74.3%, respectively. However, the AUC for the ability of the RDW to predict HS was 0.653 (95% CI = 0.589-0.716; < .001).
CONCLUSIONS
The early determination of RDW is a promising, rapid, easy and inexpensive biomarker to predict the subsequent stroke in TIA patients, especially for IS. KEY MESSAGESThe most important result of our study is to show that (1) the higher RDW, the earlier the stroke onset and (2) RDW ≥13.95% has a 2.52-fold risk of ischaemic stroke in TIA patients, and RDW ≥12.85% has a 1.51-fold risk of haemorrhagic stroke.As an economic and accessible hematological marker, baseline RDW may serve as a useful biomarker for risk stratification in TIA patients.
目的
对于许多一线临床医生来说，预测短暂性脑缺血发作（TIA）的预后较为困难。本研究旨在通过红细胞分布宽度（RDW）确定 TIA 患者是否会发生后续卒中。
材料与方法
研究期间，我们对我院卒中中心的 360 例新发 TIA 患者进行了连续研究。将患者分为三组：103 例 TIA 患者、206 例缺血性卒中（IS）患者和 51 例 TIA 后 7 天内发生脑出血（HS）的患者。所有患者均进行全血细胞计数、生化参数和脑部影像学检查。
结果
TIA 后发生 IS 和 HS 的患者的平均 RDW 值明显高于 TIA 患者（13.35±1.59 比 12.84±1.19，13.32±1.08 比 12.84±1.19，均 P≤.001）。多变量模型分析显示，RDW 与 TIA 后卒中独立相关（IS：比值比（OR）=2.52，95%置信区间（CI）=1.46-3.35，P=.002；HS：OR=1.511，95%CI=1.101-2.074，P=.011）。与 ABCD 评分相比，RDW 对 TIA 后 IS 患者的鉴别诊断效能更好（曲线下面积（AUC）：0.731 比 0.613，P=.015）。当接受 RDW 截断值为 13.95%来区分 IS 与 TIA 时，其灵敏度和特异度分别为 73.7%和 74.3%。然而，RDW 预测 HS 的 AUC 为 0.653（95%CI=0.589-0.716；P<.001）。
结论
早期确定 RDW 是一种很有前途、快速、简便且经济的预测 TIA 患者后续卒中的生物标志物，尤其适用于 IS。
关键信息
我们研究最重要的结果是：（1）RDW 越高，卒中发生得越早；（2）RDW≥13.95%时，TIA 患者发生 IS 的风险增加 2.52 倍，RDW≥12.85%时，发生 HS 的风险增加 1.51 倍。
作为一种经济且易于获取的血液学标志物，基线 RDW 可作为 TIA 患者危险分层的有用生物标志物。
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