直接经皮冠状动脉介入治疗患者血液学参数的动态变化

Dynamic changes of neotrophil and platelet counts in patients undergoing primary percutaneous coronary intervention

目的观察ST段抬高心肌梗死（STEMI）患者急性期中性粒细胞和血小板计数的动态变化，并探讨其与，0肌梗死面积及心肌灌注水平的关系。方法连续选取于发病12h内行直接经皮冠状动脉介入治疗（PCI）的STEMI患者43例，于直接PCI术前后多个时间点检测中性粒细胞和血小板计数，并分别分析与心肌酶峰值及校正TIMI帧数（CTFC）的关系，结果中性粒细胞计数于直接PCI术后24h达到最高值（8．22±3．00）×10^9／L，术后7d降至最低值（4．30±1.44）×10^9/L；血小板计数于术后72h降到最低值（195．3±61．0）×10^9／L，术后7d恢复至基线水平。中性粒细胞计数的基线值与CK峰值（r=0．406，P=0.008）和CK—MB峰值（r=0．388，P＝0.011）正相关，术后24h最高值与CK峰值（r＝0．623，P〈0．001）及CK—MB峰值（r＝0．528，P〈0．001）的相关性更为密切。血小板计数的基线值（r=-0．347，P=0．024）和最低值（r=-0．355，P=0．027）分别与CTFC呈负相关。在调整了相关的冠心病危险因素后，术后24h中性粒细胞计数对CK及CK—MB峰值的独立预测价值更高（β=0．678，P〈0．001；β=0．441，P=0．004），PCI术后72h血小板计数（β=-0．330，P=0．032）对C7FC有独立预测价值。结论行直接PCI治疗的S7EMI患者急性期尤其术后24h中性粒细胞水平升高与较大的心肌梗死范围相关；而血小板计数的最低值越低，术后心肌血流灌注程度越差。

Objective To investigate the dynamic changes of neotrophil and platelet counts in acute phase of patients with ST-segment-elevation myocardial infarction （STEMI） underwent primary, percutaneous coronary intervention （PCI） and their association with enzymatic infarct size and myocardial reperfusion. Methods Fourty-three consecutive patients with STEMI underwent primary PCI within 12 h of symptom onset were included. The neutrophil count（NC） and platelet count（PC） were obtained at admission and 24, 72 h and 7 d after PCI respectively. The correlations of the above 2 haematological indices with peak CK and CK-MB values and corrected TIMI Frame Count （CTFC） were examined. Results NC reached the highest value at 24 h after PCI [ （8.22 ±3.00） × 10^9/L] and decreased to the lowest value on the 7^th day after PCI [ （4. 30 ±1.44） × 10^9/L]. PC fell to the lowest level at 72 h after PCI [ （ 195.3 ±61.0） × 10^9/L] and returned to the baseline level on the 7^th day after PCI. Higher baseline NC was significantly associated with higher peak values of CK （ r = 0. 406, P = 0. 008 ） and CK-MB （ r = 0. 388, P = 0. 011 ） while there were strong correlations between the highest NC at 24 h afterPCI and peak values of CK （r=0.623, P〈0. O0I） and CK-MB （r=0.528, P〈0.001）. The baseline （ r = - 0. 347, P = 0. 024） and the lowest levels of PC （r = - 0. 355, P = 0. 027 ） were inversely associated with CTFC respectively. The highest NC could predict peak CK and CK-MB values（ β = 0. 678, P 〈0. 001 ; β = 0. 441 ,P = 0. 004） independently, and the lowest PC at 72 h after PCI was independent predictive factor for CTFC after adjusting relevant risk factors of coronary heart disease （ β = - 0. 330,P = 0. 032）. Conclusions In patients with STEMI understent primary PCI, increased neutrophil counts are associated with larger enzymatic infarct size, while decreased platelet counts reflect poor myocardial reperfusion after PCI.