急诊经皮冠状动脉介入治疗术后中性粒细胞水平与ST段回落及血浆N末端利钠肽原相关研究

Association of postprocedural neutrophil count,ST-segment resolution and NT-proBNP in ST elevation myocardial infarction patients after percutaneous coronary intervention

目的评价急性ST段抬高心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后中性粒细胞水平与ST段下降幅度（STR）及血浆N末端利钠肽原（NT-proBNP）相关性。方法入选发病12小时内成功接受PCI的STEMI患者195例。PCI术前、术后2小时分别记录18导联心电图，PCI术后12小时进行中性粒细胞计数和NT—proBNP水平检测，随访6个月。记录主要心脏不良事件（MACE）。根据其中性粒细胞水平分为3组：A组（中性粒细胞〈4．78×10^9／L）32例；B组[中性粒细胞（4．78～8．79）×10^9／L]118例；C组（中性粒细胞〉8．79×10^9／L）45例。结果C组PCI术后2小时STR〉70％所占比率较A组明显减少（17．8％VS43．8％，P＜0．05）；STR〈30少6组高中性粒细胞（〉8．79×10^9／L）血症、高血浆NTproBNP（〉600pmo／L）比率均明显高于STR〉70％组（33．3％vs13．8％、34．9％vs12．3％，P〈0．05或〈0．01）；直线相关分析显示，C组中性粒细胞与NT—proBNP水平呈正相关（r=0．401，P〈0．01）；随访6个月，3组MACE发生率差异无统计学意义（P〉0．05）。结论PCI后中性粒细胞水平与STR和NT—proBNP水平密切相关，PCI后中性粒细胞数早期监测有利于急性心肌梗死患者PCI后心肌组织灌注水平和临床预后的评价。

Objective To explore the correlation of postprocedural neutrophil count, ST-segment resolution （STR） and NT proBNP in ST elevation myocardial infarction patients （STEMI） after percutaneous coronary intervention（ PCI ）. Methods A total of 195 STEMI patients who underwent successful PCI were enrolled. Electrocardiograms were recorded before PCI and two hours after PCI. Neutrophii counts and NT-proBNP were measured within 12 hours after PCh Cardiac main adverse cardiac events（MACE） were also recorded during the followup survey after six months（ P 〈0.05）. According to the level of neutrophil after PCI,the patients were divided into three groups：group A（neutrophil〈4.78 × 10^9/L）,group B（neutrophil 4.28-8.79） × 10^9/L,group C（neutrophil〉 8.79 ×10^9/L）. Results Compared with group A, patients in group C less frequently had complete STR （17.8% vs 43.8%, P〈0.05）. The percentages of high neutrophil and plasma NT proBNP were significantly higher in patients with STR〈30% ,compared those in patients with STR〉70%（33.3% vs 13.8%,34.9% vs 12.3%, P 〈0.05 or 0.01）. Linear relativity analysis showed that postprocedural neutrophil count was positively correlated with the level of NT-proBNP in group C. No statistical differences were found between the groups at incidence of six months MACE（ P 〉 0.05）. Conclusion There is a strong association between postprocedural neutrophil count, STR and NT-proBNP, suggesting the early measurement of postprocedural neutrophil count is helpful in evaluating the reperfusion of myocardium and the prognosis of patients with acute myocardial infarction.