中性粒细胞与淋巴细胞比值和脑钠肽对体外循环冠状动脉旁路移植术后并发症的预测价值  

Prediction value of preoperative NLR and BNP in patients to receive on-pump coronary artery bypass grafting with post postoperative complications

作　　者：朱文明 邓伟伟 雷静 王敏[1] 高洪锋[1] ZHU Wen-ming;DENG Wei-wei;LEI Jing(Intensive Care Unit,The Cardio-cerebro Vascular Disease Hospital of Xinjiang,Urumqi 830011,China)

机构地区：[1]武汉亚洲心脏病医院新疆医院(新疆心脑血管病医院)重症医学科,新疆维吾尔自治区乌鲁木齐市830011 [2]新疆医科大附属肿瘤医院检验科

出　　处：《中国心血管病研究》2018年第10期929-933,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨冠状动脉旁路移植术（CABG）前中性粒细胞与淋巴细胞比值（NLR）、脑钠肽（BNP）水平与术后并发症之间的关系。方法选择2015年1月至2017年6月新疆心脑血管病医院在体外循环下行CABG的142例患者纳入本研究。其中男性90例、女性52例；年龄41-86（61．02±8．16）岁。于围手术期不同时段测定NLR、BNP，比较不同左心室射血分数（LVEF）患者的NLR、BNP变化差异，分析NLR、BNP与术后一系列并发症的相关性。应用Logistic回归模型、ROC曲线，获得单独或联合检测时ROC曲线下面积，分析NLR、BNP及联合检测对术后并发症的预测作用。结果术前NLR、BNP水平与LVEF呈负相关（NLR r=-0．486，BNP r=-0．508，P〈0．05），与术后一系列并发症呈正相关（NLR r=0．256-0．592，BNP r=0．276-0．612，P〈0．05）。NLR预测术后使用主动脉内球囊反搏（IABP）、新发心房颤动、肾功能不全、术后ICU停留时间〉5d的ROC曲线下面积分别0．824、0．724、0．795和0．811；BNP预测以上情况的ROC曲线下面积分别为0．842、0．730、0．801和0．816；联合（NLR＋BNP）预测的ROC曲线下面积分别是0．878、0．790、0．863和0．864。结论NLR、BNP水平能准确反映CABG患者术前的心功能状态，与CABG术后并发症密切相关，两者联合检测的预测价值优于单项。Objective To investigate the relationship between the level of neutrophil to lymphocyte ratio （NLR） and brain natriuretic peptide （BNP） before coronary artery bypass grafting （CABG） and postoperative complications. Methods 142 patients including 90 males and 52 females, received grafting from January 2015 to November 2016 were enrolled in the study in the Cardio-cerebro Vascular Disease Hospital of Xinjiang. The patients were （61.02±8.16）years old range from 41 to 86 years. The level of NLR and BNP were determined before operation, after operation, and on day 1, 2, 3 and 7 post-operation. Relationships were analyzed between NLR and BNP with LVEF, a series of adverse events. Receiver operating characteristic （ ROC ） curve analysis was performed to predict the role of NLR and BNP in postoperative complications. Results A negative correlation between NLR and BNP level with preoperative LVEF was found（NLR r=-0.486, the BNP r=-0.508, P〈0.05 ）, a series of postoperative complications were positively correlated （NLR r=0.256-0.592, the BNP r=0.276-0.612, P〈0.05 ） .NLR was used to predict postoperative IABP, new atrial fibrillation, renal failure and postoperative ICU stay of 〉5 d or mortality at 28 days, the area under the ROC curve（AUC） were 0.824, 0.724, 0.795 and 0.811 ; the area under the ROC curve（AUC） of BNP was 0.842, 0.730, 0.801 and 0.816; the area under the ROC curve （AUC） of combined detection （NLR＋BNP） was 0.878, 0.790, 0.863 and 0.864 respectively. Conclusion The preoperative NLR and BNP level is well correlated with the cardiac fimction which may be a good predictor of postoperative complications after CABG, the combined detection is superior to the single.

关 键 词：中性粒细胞与淋巴细胞比值 脑钠肽 冠状动脉旁路移植术 术后并发症 

分 类 号：R654.2[医药卫生—外科学]