白细胞计数在急诊经皮冠状动脉介入治疗术后左心室重构中的生物标记作用

目的探讨急性心肌梗死（AMI）患者白细胞计数与急诊经皮冠状动脉介入治疗（PCI）术后左心室重构的关系。方法入选接受急诊PCI治疗的sT段抬高性AMI患者117例。检测入院外周血白细胞计数以及心肌肌钙蛋白I（crrnI）、超敏C反应蛋白（hs—CRP）、N末端脑钠肽前体（NT．proBNP）等生物标记物，采用超声心动图检测左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）及左心室室壁瘤形成情况。依据人院白细胞计数将患者分为白细胞正常组（白细胞计数≤10×109/L，60例）和白细胞升高组（白细胞计数〉10×109／L，57例）。比较两组间各生物标记物以及心室重构指标的差异。以受试者工作特征（ROC）曲线计算外周血白细胞计数预测左，D室室壁瘤形成的临界值，采用多因素Logistic回归分析AMI后近期左心室室壁瘤形成的危险因素。结果白细胞升高组患者人院NT．proBNP、hs—CRP及cTnI峰值均明显高于白细胞正常组[（2408．83±3173．39）pg／L比（713．11±636．82）pg／L、（39．64±59．51）mg／L比（11．23±14．14）mg／L、（107．76±107．71）pg／L比（62．23±87．79）pg／L，P〈0．05]。入院白细胞计数与LVEDD呈显著正相关（P〈O．01），与LVEF呈显著负相关（P〈O．01）。有左心室室壁瘤患者人院白细胞计数显著高于无左心室室壁瘤患者[（12．59±5．22）×109／L比（9．27±2．60）×109/L，P=0．001]。入院白细胞计数≥10．5×109／L是AMI患者PCI术后左心室室壁瘤形成的独立危险因素（OR=22．5，95％Ch2．69—187．83，P〈0．01），其诊断AMI患者PCI术后左心室室壁瘤形成的敏感度为76．9％，特异度为69．7％。结论入院白细胞计数可能具有预测和协助诊断AMI患者急诊PCI术后近期左心室重构的价值。

Objective To study the relation between white blood cell (WBC) count and left ventricular (LV) remodeling after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods A total of 117 ST segment elevation AMI patients having underwent emergency PCI were enrolled.WBC count,cardiac troponin Ⅰ (cTnI),high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were obtained at admission before PCI.According to the WBC count level,patients were divided into normal WBC group (WBC count ≤ 10 ×109/L,60 cases) and elevated WBC group (WBC count ＞ 10 × 109/L,57 cases).Two-dimensional echocardiography was applied after PCI.The relation between WBC count and LV remodeling prognosis including LV ejection fraction (LVEF),LV end diastolic diameter (LVEDD) and LV aneurysm were compared after AMI.Results Admission NT-proBNP,hs-CRP and cTnI peak in elevated WBC group were higher than those in normal WBC group [ (2408.83 ± 3173.39) pg/L vs.(713.11 ± 636.82) pg/L,(39.64 ± 59.51) mg/L vs.(11.23 ± 14.14) mg/L,(107.76 ± 107.71) pg/L vs.(62.23 ± 87.79) pg/L,P ＜0.05].Admission WBC count was positively correlated with LVEDD and negatively correlated with LVEF (P ＜0.01 ).Patients with LV aneurysm had higher WBC count than those without LV aneurysm[ ( 12.59 ± 5.22) × 109/L vs. (9.27 ± 2.60) × 109/L,P =0.001 ].Multivariate analyses showed that admission WBC count ≥ 10.5 × 109/L was an independent determinant of LV aneurysm(OR =22.5,95％ CI:2.69-187.83,P ＜ 0.01 ),and this cut-off value yielded sensitivity of 76.9％ and specificity of 69.7％ respectively.Conclusion Admission WBC count may be considered as a prognostic biological tag in the prediction of the development of LV remodeling after emergency PCI in patients with AMI.