AbstractNumerous studies have suggested that the hemoglobin-to-red blood cell distribution width ratio (HRR) is associated with the onset, progression, and prognosis of various diseases. However, to the best of our knowledge, no research has conducted statistical analyses to determine the association between HRR and stroke.

摘要大量研究表明，血红蛋白与红细胞分布宽度比（HRR）与各种疾病的发作，进展和预后有关。然而，据我们所知，没有研究进行统计分析来确定HRR与中风之间的关联。

This cross-sectional study was conducted among adults with complete data on hemoglobin-red cell distribution width ratio (HRR) and stroke from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). HRR was calculated by dividing hemoglobin (HGB) in grams per deciliter (g/dL) by the red blood cell distribution width (RDW).

这项横断面研究是在成年人中进行的，他们拥有2005-2018年国家健康与营养调查（NHANES）中有关血红蛋白红细胞分布宽度比（HRR）和中风的完整数据。HRR是通过将血红蛋白（HGB）（以克/分升（g/dL）为单位）除以红细胞分布宽度（RDW）来计算的。

Weighted multivariable logistic regression and generalized additive models were employed to investigate the independent and nonlinear relationships between HRR and stroke. Threshold effects were assessed using two-piece linear regression models. Additionally, subgroup analyses and interaction tests were performed.

采用加权多变量logistic回归和广义加性模型研究HRR与卒中之间的独立和非线性关系。使用两段线性回归模型评估阈值效应。此外，还进行了亚组分析和相互作用测试。

A total of 36,215 participants were included, with 2.92% classified as stroke patients. The prevalence of stroke decreased across increasing tertiles of HRR (Q1: 5.07%; Q2: 2.63%; Q3: 1.69%; P < 0.0001). A negative association between HRR and stroke was observed in both unadjusted and adjusted models.

共纳入36215名参与者，其中2.92%被归类为中风患者。随着HRR三分位数的增加，卒中患病率下降（Q1:5.07%；Q2:2.63%；Q3:1.69%；P<0.0001）。在未调整和调整的模型中均观察到HRR与卒中之间的负相关。

In Model III, each one-unit increase in HRR was associated with a 58% reduction in the likelihood of stroke (Model III: OR = 0.42, 95% CI: 0.29–0.63). Subgroup analyses and interaction tests revealed that the association between HRR and stroke was BMI-dependent (P < 0.05), with the negative association only observed in participants with BMI < = 25 and BMI 25–30, but not in those with BMI > 30.

在模型III中，HRR每增加一个单位，卒中可能性就会降低58%（模型III:OR=0.42,95%CI:0.29-0.63）。亚组分析和相互作用测试显示，HRR与卒中之间的关联是BMI依赖性的（P<0.05），只有BMI<25和BMI 25-30的参与者才观察到负相关，而BMI>30的参与者则没有。

Using a two-piece linear regression model, a threshold effect was identified at a BMI of 30 (K = 1.16). To the left .

使用两段线性回归模型，在BMI为30（K=1.16）时确定阈值效应。在左边。

IntroductionStroke is a globally prevalent disease, with approximately 15 million new cases reported each year1. It is recognized as the second leading cause of death and the third leading cause of disability worldwide2. In the United States, around 140,000 individuals die from stroke annually, with stroke accounting for about 1 in every 20 deaths3.

引言中风是一种全球流行的疾病，每年报告约1500万例新病例1。它被公认为全球第二大死亡原因和第三大残疾原因2。在美国，每年约有140000人死于中风，中风约占每20人死亡人数的1/3。

Despite advancements in prevention and healthcare that have contributed to a gradual decline in stroke mortality4, the prevalence and incidence of stroke continue to rise, and the average age of onset is decreasing. Key factors such as hypertension, diabetes, coronary artery disease, oxidative stress, and inflammation play critical roles in the pathogenesis of stroke5,6,7.Hemoglobin (HGB), a protein abundant in red blood cells (RBCs), functions primarily as an oxygen transport molecule and is widely utilized as a key biochemical marker for diagnosing anemia8.

尽管预防和保健方面的进步导致中风死亡率逐渐下降4，但中风的患病率和发病率继续上升，平均发病年龄正在下降。高血压，糖尿病，冠状动脉疾病，氧化应激和炎症等关键因素在中风的发病机制中起着至关重要的作用5,6,7。血红蛋白（HGB）是一种富含红细胞（RBC）的蛋白质，主要起氧转运分子的作用，被广泛用作诊断贫血的关键生化标志物8。

Due to the direct connection between the central nervous system, blood circulation, and the delivery of oxygen to tissues, anemia is closely associated with both the onset and progression of stroke9. Additionally, anemia increases the levels of inflammatory mediators, resulting in worse outcomes for stroke patients10.

由于中枢神经系统，血液循环和氧气输送到组织之间的直接联系，贫血与中风的发生和发展密切相关9。此外，贫血会增加炎症介质的水平，导致中风患者的预后更差10。

The degree of heterogeneity in circulating red blood cell (RBC) volume, commonly referred to as anisocytosis, is typically quantified using a simple formula. This calculation divides the standard deviation (SD) of RBC volume by the mean corpuscular volume (MCV), followed by multiplying by 100 to express it as a percentage (i.e.

循环红细胞（RBC）体积的异质性程度（通常称为异细胞增多症）通常使用简单的公式进行量化。该计算将红细胞体积的标准偏差（SD）除以平均红细胞体积（MCV），然后乘以100以表示其百分比（即。

[SD of RBC volume]/[MCV] × 100). The result of this formula is termed the red cell distribution width (RDW), which therefore serves as a parameter reflecting the heterogeneity of circulating RBC volume. Since RDW is mathematically d.

[红细胞体积的SD]/[MCV]×100）。这个公式的结果被称为红细胞分布宽度（RDW），因此它可以作为反映循环红细胞体积异质性的参数。因为RDW在数学上是d。

Data availability

数据可用性

The complete dataset is accessible through the NHANES database, which can be located at the following link: https://www.cdc.gov/nchs/nhanes/index.htm.

可以通过NHANES数据库访问完整的数据集，该数据库可以位于以下链接：https://www.cdc.gov/nchs/nhanes/index.htm.

AbbreviationsHRR:

缩写HRR：

Hemoglobin-red cell distribution width ratio

血红蛋白红细胞分布宽度比

BMI:

体重指数：

Body mass index

体重指数

WBC:

白细胞：

White blood cels

白细胞

RBC:

红细胞：

Red blood cells

红细胞

PLT:

PLT公司：

Platelet

血小板

TC:

技术委员会：

Total cholesterol

总胆固醇

TG:

甘油三酯：

Triglyceride

甘油三酯

HDL-c:

高密度脂蛋白胆固醇：

High-density lipoprotein cholesterol

高密度脂蛋白胆固醇

LDL-c:

低密度脂蛋白胆固醇：

Low density lipoprotein cholesterol

低密度脂蛋白胆固醇

Scr:

Scr（可控硅）：

Serum creatinine

血清肌酐

BUN:

尿素氮：

blood urea nitrogen

血尿素氮

HGB:

HGB公司：

Hemoglobin concentration

血红蛋白浓度

RDW:

RDW：

Red cell distribution width

红细胞分布宽度

CHD:

冠心病：

Coronary heart disease

冠心病

95% CI:

95% confdence interval

95%置信区间

OR:

Odds ratio

优势比

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Yang, L., Chen, X., Cheng, H. & Zhang, L. Dietary copper intake and risk of stroke in adults: A case-control study based on national health and nutrition examination survey 2013–2018. Nutrients 14(3), 409 (2022).Download referencesAcknowledgementsWe would like to thank all participants in NHANES study.FundingThe author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.Author informationAuthor notesThese authors contributed equally: Shao Xie and Lei Wang.Authors and AffiliationsDepartment of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221002, Jiangsu Province, ChinaYang Xiong, Shao Xie, Yuancheng Yao, Yuliang Chen, Jiahai Ding, Runchuan Zhou, Yusun Zhang, Lei Wang & Yong LiuDepartment of Medical Oncology, Jinling Hospital, Nanjing University of Chinese Medicine, Nanjing, 210000, ChinaWanyi LiuAuthorsYang XiongView author publicationsYou can also search for this author in.

Yang，L.，Chen，X.，Cheng，H。＆Zhang，L。膳食铜摄入量与成人中风风险：基于2013-2018年国家健康与营养检查调查的病例对照研究。营养素14（3），409（2022）。下载参考文献致谢我们要感谢NHANES研究的所有参与者。资助作者声明，本文的研究，作者和/或出版物未获得任何财务支持。作者信息作者注意到这些作者做出了同样的贡献：邵燮和王磊。作者和附属机构徐州医科大学附属医院神经外科，江苏省徐州市淮海西路99号，221002，中国杨雄，邵燮，姚元成，陈玉良，丁家海，周润川，张玉孙，王磊，刘勇南京中医药大学金陵医院肿瘤内科，南京210000，刘万义作者杨雄观点作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsYX: Conceptualization, Data curation, Formal analysis, Writing – original draft.SX: Conceptualization, Data curation, Formal analysis, Writing – review & editing. YY: Methodology, Validation, Writing – review & editing.YC: Conceptualization, Supervision, Writing – review & editing.

PubMed谷歌学术贡献SYX：概念化，数据管理，形式分析，写作-原稿。SX：概念化，数据管理，形式分析，写作-评论和编辑。YY：方法论，验证，写作-评论和编辑。YC：概念化，监督，写作-评论和编辑。

JD: Data curation, Formal analysis.RZ: Conceptualization, Data curation. WL: Writing – original draft. YZ: Conceptualization. LW: Writing – review & editing.YL: Writing – review & editing.Corresponding authorCorrespondence to.

JD：数据管理，形式分析。RZ：概念化，数据管理。WL：写作-原稿。YZ：概念化。LW：写作-评论和编辑。YL：写作-评论和编辑。对应作者对应。

Yong Liu.Ethics declarations

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Competing interests

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The authors declare no competing interests.

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Ethics approval

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The studies involving humans were approved by the National Center for Health Statistics Research Ethics Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study..

涉及人类的研究得到了国家卫生统计研究伦理审查委员会的批准。这些研究是根据当地立法和机构要求进行的。参与者提供了书面知情同意书以参加本研究。。

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Reprints and permissionsAbout this articleCite this articleXiong, Y., Xie, S., Yao, Y. et al. Hemoglobin-to-red blood cell distribution width ratio is negatively associated with stroke: a cross-sectional study from NHANES.

转载和许可本文引用本文Xiong，Y.，Xie，S.，Yao，Y。等人。血红蛋白与红细胞分布宽度比与中风呈负相关：NHANES的横断面研究。

Sci Rep 14, 28098 (2024). https://doi.org/10.1038/s41598-024-79520-xDownload citationReceived: 25 September 2024Accepted: 11 November 2024Published: 15 November 2024DOI: https://doi.org/10.1038/s41598-024-79520-xShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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KeywordsStrokeHemoglobin-to-red cell distribution width ratioNHANESPopulation-based study‌Cross-sectional study

关键词中风血红蛋白对红细胞分布宽度的定量研究基于人群的研究横断面研究