摘要
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.
出处
《中国心血管杂志》
2009年第2期93-96,共4页
Chinese Journal of Cardiovascular Medicine
关键词
心肌梗死
血管成形术
经腔
经皮冠状动脉
血液学试验
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Hematologic tests