红细胞分布宽度-白蛋白比值与接受静脉-动脉体外膜肺氧合支持的急性暴发性心肌炎患儿院内死亡风险的关联性研究  

Association between red cell distribution width to albumin ratio and the in-hospital mortality in pediatric acute fulminant myocarditis patients receiving veno-arterial extracorporeal membrane oxygenation

作　　者：周晶晶 邵钧捷[1,2] 岳帅 闫浩杰 史树锦 洪小杨 张然 Zhou Jingjing;Shao Junjie;Yue Shuai;Yan Haojie;Shi Shujin;Hong Xiaoyang;Zhang Ran(Department of Cardiovascular Medicine,The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Graduate School,Chinese PLA Medical School,Beijing 100853,China;Department of Pediatrics,The Seventh Medical Center of Chinese PLA General Hospital,Beijing 100700,China)

机构地区：[1]中国人民解放军总医院第一医学中心心血管内科,北京100853 [2]中国人民解放军医学院研究生院,北京100853 [3]中国人民解放军总医院第七医学中心儿科医学部,北京100700

出　　处：《中国医学前沿杂志（电子版）》2024年第5期59-66,共8页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：国家重点研发计划(2021YFC2701700,2021YFC2701703)。

摘　　要：目的探究红细胞分布宽度-白蛋白比值(red cell distribution width to albumin ratio,RAR)与接受静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation,VA-ECMO)支持的急性暴发性心肌炎(acute fulminant myocarditis,AFM)患儿院内死亡风险的关联性。方法选取2015年7月至2022年8月于中国人民解放军总医院第七医学中心及其他6个ECMO中心因AFM接受VA-ECMO治疗的患儿125例。根据受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)确定RAR截断值,并分为RAR<0.38组和RAR≥0.38组。采用二元Logistic回归评估RAR与院内死亡风险的关联性。结果研究期间36例(28.8%)患儿发生院内死亡。校正潜在混杂因素后,RAR每增加1个标准差,院内死亡风险增加93%(OR=1.93,95%CI:1.1~3.39,P=0.022)。与RAR<0.38组相比,RAR≥0.38的院内风险增加6.5倍(OR=7.5,95%CI:1.85~30.32,P=0.005)。限制性立方样条图显示,RAR与院内死亡风险之间存在正线性关系(Pnonlinear=0.325)。亚组分析发现,性别与RAR在评估院内死亡发生风险上存在交互作用。结论RAR升高与AFM患儿VA-ECMO院内死亡高风险相关,提示RAR可能是临床预后判断的新型分子标志物。Objective To investigate the association between red cell distribution width to albumin ratio(RAR)and the risk of in-hospital mortality in pediatric patients with acute fulminant myocarditis(AFM)receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)support.Methods A total of 125 pediatric patients receiving VA-ECMO support for AFM at the Seventh Medical Center of Chinese PLA General Hospital and six other ECMO centers across China from July 2015 to August 2022 were selected.The optimal cut-off value of RAR was determined based on the receiver operating characteristic(ROC)curve,and the patients were divided into RAR<0.38 and RAR≥0.38 groups.Binary logistic regression analysis was used to assess the association between RAR and the in-hospital mortality.Results A total of 36(28.8%)pediatric patients experienced in-hospital death during the study period.After correcting for potential confounders,per 1 standard deviation(SD)increase in RAR was associated with a 93% increase in the risk of in-hospital mortality(OR=1.93,95%CI:1.1-3.39,P=0.022).Compared with the RAR<0.38 group,the RAR≥0.38 group had a 6.5-fold increase in-hospital mortality(OR=7.5,95%CI:1.85-30.32,P=0.005).Restricted cubic splines(RCS)analysis showed a positive linear relationship between RAR and the risk of in-hospital mortality(Pnonlinear=0.325).Subgroup analysis revealed an interaction between gender and RAR on the in-hospital mortality in pediatric patients with AFM receiving VAECMO.Conclusions Elevated RAR is associated with a high risk of in-hospital mortality in pediatric patients with AFM receiving VA-ECMO support,indicating RAR may serve as a novel molecular biomarker to assess clinical prognosis.

关 键 词：静脉-动脉体外膜肺氧合 急性暴发性心肌炎 红细胞分布宽度 白蛋白 

分 类 号：R73[医药卫生—肿瘤]