急性ST段抬高型心肌梗死早期再灌注后白细胞与心脏事件的关系

Relation of white blood cell count and cardiac events changes in patients with acute ST-segment elevation myocardial infarction treated with reperfusion

目的探讨急性ST段抬高型心肌梗死（sTEMI）患者早期再灌注治疗后外周血白细胞（WBC）计数与心脏事件的关系。方法对收治的235例STEMI患者进行早期再灌注治疗，根据病情及患者意愿将患者分为冠状动脉介入治疗组（PCI组，97例）和阿替普酶溶栓治疗组（溶栓组，138例），对治疗前与治疗后3h、2d、3dWBC计数和治疗后3d心脏事件发生的次数进行比较，并观察两者之间的关系。结果两组患者治疗后3h外周血WBC计数与治疗前比较差异无统计学意义（P〉0．05），治疗后2d、3dWBC计数显著降低且PCI组显著低于溶栓组（P均〈0．05）。治疗后两组间未发生心脏事件、2次心脏事件发生率比较差异无统计学意义（P〉0．05）；PCI组1次心脏事件发生率高于溶栓组，差异有统计学意义（P〈0．05），3次及以上心脏事件发生率低于溶栓组，差异有统计学意义（P〈0．05）。WBC计数与心脏事件发生数量呈正相关（r=0．231，P〈0．05）。结论STEMI患者经过早期再灌注治疗后WBC计数与心脏事件明显降低，WBC计数与心脏事件呈正相关。

Objective To study the relationship between white blood cell（WBC） count and cardiac events in acute ST-elevation myocardial infarction（STEMI） patients treated with reperfusion in the early stage. Methods Two hundred and thirty-five patients with acute STEMI were divided into two groups： percutaneous coronary intervention group （PCI group, 97 patients） and thrombosis therapy group （138 patients）. WBC count and cardiac events of the two groups before and after treatment （3 h and the second day and the third day） were recorded and compared. Results The level of WBC count had no changes in two groups before and after treatment in first 3 h （P 〉 0.05） , while the level of WBC count was significantly decreased, and the level of WBC count was significantly lower in PCI group than that in thrombosis therapy group （P 〈 0.05）. The rate of no cardiac events and two cardiac events in two groups has no significant differences （P 〉 0.05）. The rate of one cardiac events in PCI group was significantly higher than that in thrombosis therapy group （P 〈 0.05）. The rate of three cardiac events in PCI group was significantly lower than that in thrombosis therapy group （P 〈 0.05）. WBC count had a positive correlation with cardiac events rate （r = 0.231, P 〈 0.05）. Conclusions Primary percutaneous coronary intervention decreases WBC count and cardiac events rate. In patients with acute myocardial infarction, level of WBC count has positive relationship with cardiac events.