Mitchell Elizabeth, Cheatham John P, Sisk James M, Nicholson Lisa, Holzer Ralf, Galantowicz Mark, Cua Clifford L
Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
Congenit Heart Dis. 2014 Nov-Dec;9(6):543-8. doi: 10.1111/chd.12174. Epub 2014 Apr 4.
Hybrid procedure is an alternative initial palliation for patients with hypoplastic left heart syndrome (HLHS). One major complication with this procedure is stenosis in the aortic arch isthmus possibly due to inflammation from the patent ductus arteriosus (PDA) stent. In adult studies, neutrophil/lymphocyte (N/L) ratio has been used as a marker for increased inflammation and has been associated with increased risk for coronary artery stent stenosis. The goal of this study was to determine if there were differences in N/L ratio between patients with HLHS undergoing hybrid procedure that required an arch intervention (AI-Group) vs. those that did not require an intervention (NAI-Group).
Retrospective chart review was performed on patients with HLHS undergoing hybrid procedure between July 2002 and January 2013. Complete blood counts as well as differentials were recorded at four time periods: 1 day prehybrid palliation, one day posthybrid palliation, 1 week posthybrid palliation, and 3 weeks posthybrid palliation.
One hundred six patients were evaluated (AI-Group = 38, NAI-Group = 68). AI-Group generally had a higher N/L ratio vs. NAI-group and this was significant immediately 1 day posthybrid palliation: AI-Group vs. NAI-Group, prehybrid (2.95 ± 2.62 vs. 2.44 ± 1.71), 1 day posthybrid (5.95 ± 4.16 vs. 4.34 ± 3.87, P < .05), 1 week posthybrid (2.72 ± 3.01 vs. 2.28 ± 2.12), and 3 weeks posthybrid (1.85 ± 1.24 vs. 1.45 ± 1.16), respectively. Lymphocyte percentage was significantly lower in the AI-Group vs. NAI-Group 3 weeks posthybrid palliation (33.00 + 11.30% vs. 40.65 + 16.82%).
Patients that required an arch intervention after hybrid palliation had a higher N/L ratio immediately after the procedure. This may signify increased inflammatory reaction that places these patients at risk for stenosis. Future studies are needed to determine if N/L ratio is a robust marker to risk stratify patients undergoing the hybrid procedure for arch complications.
杂交手术是左心发育不全综合征（HLHS）患者初始姑息治疗的一种替代方法。该手术的一个主要并发症是主动脉弓峡部狭窄，可能是由于动脉导管未闭（PDA）支架引发的炎症所致。在成人研究中，中性粒细胞/淋巴细胞（N/L）比值已被用作炎症增加的标志物，并与冠状动脉支架狭窄风险增加相关。本研究的目的是确定接受需要进行主动脉弓干预的杂交手术的HLHS患者（AI组）与不需要干预的患者（非AI组）之间的N/L比值是否存在差异。
对2002年7月至2013年1月期间接受杂交手术的HLHS患者进行回顾性病历审查。在四个时间段记录全血细胞计数及分类：杂交姑息治疗前1天、杂交姑息治疗后1天、杂交姑息治疗后1周和杂交姑息治疗后3周。
共评估了106例患者（AI组 = 38例，非AI组 = 68例）。AI组的N/L比值通常高于非AI组，且在杂交姑息治疗后1天差异显著：AI组与非AI组，杂交前（2.95±2.62对2.44±1.71），杂交后1天（5.95±4.16对4.34±3.87，P <.05），杂交后1周（2.72±3.01对2.28±2.12），以及杂交后3周（1.85±1.24对1.45±1.16）。杂交姑息治疗后3周，AI组的淋巴细胞百分比显著低于非AI组（33.00 + 11.30%对40.65 + 16.82%）。
杂交姑息治疗后需要进行主动脉弓干预的患者术后立即具有较高的N/L比值。这可能表明炎症反应增加，使这些患者面临狭窄风险。未来需要进行研究以确定N/L比值是否是对接受杂交手术治疗主动脉弓并发症的患者进行风险分层的可靠标志物。
