急性心肌梗死患者经皮冠脉介入术后白细胞/淋巴细胞比值与冠脉无复流的相关性

目的旨在探讨急性ST段抬高型心肌梗死（aucte st-segment elevation myocardial infarction，STEMI）患者经皮冠脉介入术后白细胞／淋巴细胞比值与冠脉无复流的相关性。方法连续性入选2012年5月～2013年10月就诊于广东省梅州市梅县人民医院的60例STEMi患者，以及64例健康志愿者，这些人表示6h内出现过胸痛等临床症状。根据心肌梗死溶栓血流分级（Thrombolysis in Myocardial Infarction，TIMI），将STEM患者分成2组。经皮冠脉介入术后，TIMI血流分级为0、1、2，称为无复流；TIMI血流分级为5则表示手术成功。使用两样本t检验或者X^2检验比较2组间临床特点和白细胞／淋巴细胞比值差异。结果2组患者糖尿病、高血压及吸烟比例相似（分别为19．3％比228％，545％比307％，54．5％比507％，P均〉0.05）。同时，2组间空腹血糖、尿素氮、肌酐水平差异无统计学意义[分别为（1270±422）mg／dL比（123.5±62.0）mg／dL，（29．5±／51）mg／dL比（276±8．0）mg／dL，（0.91±0.51）mg／d 比（0．86±0．56）mg／dL，P均〉0．05]。而STEMI患者的白细胞／淋巴细胞比值依旧很高[（7.1±4.6）比L（2．3±17），P〈0.001另外，无复流组的白细胞／淋巴细胞细胞比值同样很高[（13．1±4．5）比（5．3±27），P〈0．001]。

Objective The aim of this study is to investigate the relationship between hematologic parameters and post primary PCI coronary no-reflow. Methods A total of 60 consecutive STEMI patients and healthy volunteer admitted within 6 hours from symptom onset were enrolled to the study in the cardiology clinics. The STEMI patients were divided into 2 groups based on the Thrombolysis In Myocardial Infarction （TIMI） flow grade. No-reflow was defined as post-PCI TIM1 Flow Grade 0, 1 or 2 and angiographic success was defined as TIMI Grade 3 Flow. The differernces of clinical characteristic and neutrophil/lymphocyte between two groups were compared by student T orZ 2 test. Results Diabetes mellitus hypertension and smoking status were similar between groups （19.3% vs 22.8%, 34.5% vs 30.7%, 34.5% vs 30.7%,respectively all P〈0.05）. With respect to baseline laboratory status, fasting glucose, blood urea nitrogen, creatinine levels were not significantly different between groups [（127.0±42.2）mg/dL vs （123.5±62.0） mg/dL, （29.5±15.1） mg/dL vs （27.6±8.0） mg/dL, （0.91±0.51） mg/dL vs （0.86±0.36） mg/dL,all P〈0.05）]. The neutrophil/lymphocyte （N/L） ratio was also significantly higher in STEMI group [（7.1±4.6） vs （2.3±1.7）, P〈0.001）]. Additionally, N/L ratio was also significantly higher in No-reflow group （TIM/Flow Grade 0, 1 or 2） group [（13.1±4.5） vs （5.3±12.7）, P〈0.001]. Conclusion The N/L ratio, which is cheaply and easily measurable laboratory data is independently associated with post primary PCI coronary no-reflow.