白细胞计数对早期急性心肌梗死的诊断价值

Value of leukocyte count in diagnosis of early acute myocardial infarction

目的：探讨WBC计数在急性心肌梗死（acute myocardial infarction，AMI）中的早期诊断价值。方法：选择AMI早期就诊患者47例（胸痛时间〈2h，肌红蛋白阴性，无其他炎症相关疾病），分别于入院即刻和胸痛发生后4—8h、12～24h采集静脉血，分别检测WBC、C反应蛋白（CRP）、心肌肌钙蛋白I（cTNI）与肌红蛋白（Mb）。并于出院后3—12个月，跟踪监测WBC3次，取其平均值作为自身对照。同时检测健康人群WBC和CRP作正常对照。结果：AMI胸痛发作2h内，在Mb阴性时，WBC即开始升高（9．12±2．18）×10^9／L，显著高于自身对照（6．49±1．09）×10^9／L和正常对照组（5．97±1．24）×10^9／L（P〈0．01）。但中性粒细胞与自身对照相比差异无统计学意义（P〉0．05）；CRP与对照组相比差异无统计学意义（P〉0．05）。在Mb和cTNI阳性后WBC和CRP显著升高（P〈0．01），在12～24h达峰值，分别为（12．46±5．28）×10^9／L和（50．9±21．3）×10^9／L，同时中性粒细胞也显著升高（P〈0．01）。结论：AMI发作早期，Mb和cTNI阴性时，WBC即显著升高，因此WBC计数对早期AMI有一定的诊断价值。

Objective：To investigate the diagnostic value of changes of leukocyte count in patients with acute myocardial infarction （AMI）. Methods ： A total of 47 patients with AMI were selected according to the following standards ： the chest pain lasted for no more than 2 hours,the myoglobin （Mb） was negative, and no one had diseases related to inflammation. The blood samples were obtained respectively at the time of onset,4 -8 h and 12 -24 h after the chest pain. And the leukocyte-reactive protein, cardiac troponin I （cTNI） and Mb were detected. All the patients were followed up for 3 - 12 months. During this period, their WBC was examined for three times, and the mean value was compared with that of the autoleukocyte controls as well as that of the normal control. Results： Within 2 hours of the onset of chest pain and with the Mb still negative, the leukocyte count in the AMI patients began to rise （9.12 ± 2.18）×10^9/L,which was higher than that of the autoleukocyte controls（6.49 ± 1.09） ×10^9/L and the normal control（5.97 ± 1.24） ×10^9/L（ P 〈 0. 01 ）. But neutrophil percentage presented no significant difference between AMI patients and the autoleukocyte controls at the time of onset（ P 〉 0.05 ）. There was no significant difference in C reactive protein （CRP）levels between AMI patients and the normal control at the time of onset（ P 〉 0.05 ）. The levels of WBC and CRP in AMI patients increased significantly after Mb and cTNI became positive（P 〈 0.01 ）, and reached their peak at 12 -24 hours after the onset of chest pain. At the same time neutrophil percentage increased significantly, too（ P 〈 0.01 ）. Conclusions：The white cell count begins to rise significantly at the onset of acute myocardial infarction when the Mb and cTNI are still negative. So the increase of leukocyte count is one of the early symptoms of AMI.