Moosmann Julia, Schroeder Christian, Cesnjevar Robert, Rottermann Kathrin, Weigelt Annika, Dittrich Sven
Department of Pediatric Cardiology, University of Erlangen-Nürnberg, Erlangen, Germany.
Department of Pediatric Cardiac Surgery, University of Erlangen-Nürnberg, Erlangen, Germany.
Front Pediatr. 2021 Dec 8;9:740951. doi: 10.3389/fped.2021.740951. eCollection 2021.
Reliable laboratory parameters identifying complications after Fontan surgery including the lymphatic abnormalities and the development of protein-losing enteropathy (PLE) are rare. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocte ratio (PLR) are inflammatory markers and have been studied to predict outcome and prognosis in various diseases. The aim of this study was to investigate NLR and PLR from birth to follow-up after Fontan and evaluate their use as prognostic parameters for single ventricle patients regarding the development of lymphatic malformations during follow-up. Sixty-six univentricular patients who underwent Fontan surgery and had 6-month follow-up magnetic resonance imaging (MRI) with T2 weighted lymphatic imaging after total cavopulmonary connection (TCPC) surgery were included in the study. NLR and PLR were determined at specific time points, from neonatal age to follow-up after Fontan operation and correlated to data from the MRI 6 months after Fontan. NLR and PLR increase significantly over time from the first surgery during infancy to the follow-up after Fontan (both < 0.0001), with a significant increase after the Glenn surgery for both ratios (each < 0.0001). Higher NLR ( = 0.002) and higher PLR ( = 0.004) correlated with higher-grade classification of lymphatic abnormalities in T2-weighted imaging 6 months after Fontan surgery and higher NLR correlated with higher transpulmonary gradient prior to Fontan surgery ( = 0.035) Both ratios showed a significant correlation to total protein at follow-up (NLR = 0.0038; PLR<0.0001). Increased NLR and PLR correlate with higher degree lymphatic malformations after TCPC and therefore might contribute as valuable additional biomarker during follow-up after TCPC. NLR and PLR are simple, inexpensive and easily available parameters to complement diagnostics after TCPC.
能够可靠识别Fontan手术（包括淋巴系统异常和蛋白丢失性肠病（PLE）的发生）后并发症的实验室参数很少见。中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）是炎症标志物，已被研究用于预测各种疾病的结局和预后。本研究的目的是调查从出生到Fontan手术后随访期间的NLR和PLR，并评估它们作为单心室患者随访期间淋巴畸形发展的预后参数的用途。本研究纳入了66例接受Fontan手术且在全腔静脉肺动脉连接（TCPC）手术后6个月进行了T2加权淋巴成像的随访磁共振成像（MRI）的单心室患者。在从新生儿期到Fontan手术后随访的特定时间点测定NLR和PLR，并将其与Fontan手术后6个月的MRI数据相关联。从婴儿期的首次手术到Fontan手术后的随访，NLR和PLR均随时间显著增加（均P<0.0001），Glenn手术后这两个比值均显著增加（均P<0.0001）。较高的NLR（P = 0.002）和较高的PLR（P = 0.004）与Fontan手术后6个月T2加权成像中淋巴异常的更高分级相关，较高的NLR与Fontan手术前更高的跨肺压差相关（P = 0.035）。两个比值在随访时均与总蛋白显著相关（NLR P = 0.0038；PLR P<0.0001）。TCPC后NLR和PLR升高与更高程度的淋巴畸形相关，因此可能作为TCPC后随访期间有价值的额外生物标志物。NLR和PLR是简单、廉价且易于获得的参数，可用于补充TCPC后的诊断。
