早期中性粒细胞与淋巴细胞比值与心脏术后体外膜肺氧合辅助患者结局相关性研究

摘要

Objective The neutrophil-to-lymphocyte ratio (NLR) is a biological marker that partly reflects the severity of systemic inflammation. The objective of this study was to assess the association between NLR and outcome from extracorporeal mem⁃brane oxygenation ( ECMO) support in postcardiotomy cardiogenic shock ( PCS) patients. Methods We performed a retrospective ob⁃servational study of 69 postcardiotomy patients with ECMO supportfrom January 2011 to December 2012. Patients with ECMO support duration less than 48 hours were excluded. The NLRs before ECMO support, on the day starting ECMO support, 1st day and 2nd day after ECMO support were analyzed.Results Fifty two (75.4%) patients successfully weaned from ECMO, 33 discharged. The survival rate after ECMO weaning was 63.5% and the total in-hospital survival rate was 47.8%. NLR of all patients elevated significantly after ECMO commenced.NLR in survival group were higher than non-survival group on 1st(18.6±10.8 vs 13.4±7.3, P =0.020) and 2nd (21.1±11.8 vs 15.2±7.2, P=0.008) day after ECMO support. Sixty nine patient were divided into three tertiles (T1, T2, and T3) by NLR on 1st after ECMO support. The in-hospital survival rate in T1 (7.8±1.6, mean NLR), T2(13.4±1.9,mean NLR), and T3(26. 6±8.7, mean NLR) was separately 30.4%, 47.8%, and 65.2% ( P =0.019). The survival rate after ECMO weaning was separately 50.0%, 57.9%, and 78.9% in T1, T2, and T3. Conclusion The survivals from ECMO support in PCS patients tend to have higher NLR in the early phase and may suffer from comparatively more intensive systemic inflammation. More clinical and experimental re⁃search should be conducted to illustrate the mechanisms of systemic inflammation during ECMO support.%目的：中性粒细胞与淋巴细胞比值（ NLR）是一种常用的炎症反应评价指标，本研究将探究心脏术后心源性休克（ PCS）应用体外膜肺氧合（ ECMO）辅助患者NLR与预后的关联。方法回顾性分析2011年1月至2012年12月因PCS行ECMO辅助且ECMO辅助时间大于48 h的患者69例，采集患者ECMO辅助前、辅助后当日、辅助后第1及第2日的NLR进行分析。结果69例患者中52例（75．4％）成功脱离ECMO，33例（47．8％）顺利出院，占脱机患者的63．5％。所有患者的NLR均在ECMO辅助后显著并持续升高，生存组ECMO辅助后第1日（18．6±10．8）vs（13．4±7．3）（ P ＝0．020）、第2日（21．1±11．8）vs （15．2±7．2）（ P ＝0．008）NLR要显著高于死亡组。将所有患者按照ECMO辅助后第1日NLR的三分位数分为低、中、高（T1、T2、T3）三组，住院期间生存率分别为30．4％、47．8％、65．2％（ P ＝0．019），ECMO撤机后生存率分别为50．0％、57．9％、78．9％。结论 PCS应用ECMO进行辅助的存活患者与死亡患者相比，早期具有较高的NLR，高NLR组具有较高的生存率及ECMO撤机后的生存率可能与较强烈的急性炎症有关。但需要进一步的临床、基础研究阐释ECMO辅助后的转归情况。