紅血球分佈寬度作為心房顫動輔助診斷標記之臨床價值

The Clinical Value of Red Blood Cell Distribution Width as an Auxiliary Diagnostic Marker of Atrial Fibrillation

心房顫動（Atrial fibrillation|AF）是臨床上最常見的心臟節律異常病徵，台灣盛行率約1-2%，其發生腦中風機率更為常人五倍以上（AF：3.8 % vs Normal：0.45 %）。近年來許多研究中指出RDW被認為是一個可以做為氧化壓力和發炎反應的生物指標，而氧化壓力則在心房顫動的發病上扮演著重要角色，因此RDW 被認為與心房顫動間可能具有關聯性。本篇研究中遂針對心房顫動的族群以病歷回溯方法，蒐集2015年1月至2016年12月間於本院進行心電圖及血液檢查之實驗室報告做為分析資料（N=588），以SPSS進行統計分析，藉以了解RDW用於輔助診斷心房顫動之價值。分析結果發現，各項心血管疾病預測因子的比較中（BNP、RDW-CV、hs-TnI、hs-CRP、BUN），心房顫動族群皆顯著高於對照組（＜0.01），且心房顫動的發生率也與RDW-CV的數值呈現正相關性（p＜0.001）。雖隨著年齡提高RDW-CV有上升的趨勢，但個別分析後可發現年齡並非主要影響因子。若利用本篇研究中RDW-CV用於判定心房顫動（AF）之最適切點（13.95%），協同BNP（診斷參考值 ＞100 pg/ml）用於臨床上心房顫動（AF）的輔助診斷，可有效將整體診斷特異性由54.4%提升至93.0%，同時將靈敏度由82.8%提升至87.5%（＜0.001）。RDW-CV通常含括在全血細胞計數報告中，並且在大多數臨床環境中是容易獲得的數據，若能與其他相關指標合併評估使用，對於臨床上心房顫動病徵的診斷相信能提供潛在助益。

The Atrial Fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. The prevalence rate in Taiwan is about 1-2%, and the rate of cerebrovascular stroke is five times higher than usual (AF: 3.8% vs Normal: 0.45%). For the past few years, many studies has shown that Red blood cell distribution (RDW) is considered a biological indicator related to oxidative stress and inflammatory response. In addition, oxidative stress, and inflammation response play an important role in the pathogenesis of the AF| hence the value of RDW may be considered to be related to the AF. In this study, we targeted the group of the AF, by using the Retrospective Method, to gathered laboratory reports of ECG and blood tests performed in the hospital from January 2015 to December 2016 as analysis data (N = 588) and SPSS was used afterwards for statistical analysis to understand the value of RDW in assisting diagnosis of the AF. The analysis results of various cardiovascular predictors (BNP, RDW-CV, hs-TnI, hs-CRP, BUN) shows that the AF group was significantly higher than comparison group (＜0.01), moreover, the incidence of the AF is also positively correlated with the value of RDW-CV (p ＜0.001). Although the RDW-CV tends to increase with age in analysis, the age is not the main factor show in comparison analysis. Based on the study, determined the cut-off point as RDW-CV(13.95%) of the AF by SPSS, if this judgment value used in conjunction with BNP (diagnostic reference value ＞100 pg/ml) for clinical diagnosis of the AF, it will effectively improve the overall diagnostic specificity from 54.4% to 93.0%, while increasing the sensitivity from 82.8% to 87.5% (＜0.001). The RDW-CV usually included in Complete Blood Count (CBC) report and is easily obtain in most clinical examinations. If combined with other related indicators, sure to provide potential benefits for clinical diagnosis of the AF.