白细胞计数及其分类对急性心肌梗死的诊断价值

The value of white blood cell count and its classification in acute myocardial infarction

目的探讨白细胞(WBC)计数及其分类对急性心肌梗死(AMI)的诊断价值。方法回顾性分析西安交通大学第二附属医院心血管内科冠状动脉造影患者195例,其中ST段抬高型急性心肌梗死(STEMI)患者60例和非ST段抬高型急性心肌梗死(NSTEMI)患者66例作为病例组;非AMI患者69例作为对照组。比较各组WBC计数、肌钙蛋白I(TNI)、B型前脑尿钠肽(BNP)、血糖、血脂、心肌酶谱的结果。结果 WBC计数、中性粒细胞计数(N)及中性粒细胞淋巴细胞比值(NLR)均表现为STEMI组、NSTEMI组、对照组依次逐渐降低(P<0.05)。N对STEMI诊断的受试者工作特征(RCO)曲线下面积(AUC)最大(AUC=0.865;95%CI:0.813~0.917)。N和TNI联合诊断STEMI的AUC大于两者分别单独使用(AUC=0.887 7;95%CI:0.840 9~0.934 5)。结论 N在STEMI有较高的诊断价值,同时对AMI的分型有较好的辅助意义。

Objective To explore the diagnostic value of white blood cell count and its classification in acute myocardial infarction.Methods A retrospective analysis was made on the clinical data of 195 cases undergoing coronary angiography,which were divided into the case group and the control group.The case group was comprised of 60 cases of ST elevation acute myocardial infarction（STEMI）and 66 cases of non ST elevation myocardial infarction（NSTEMI）while 69 cases of non-acute myocardial infarction（AMI）were used as control group.White blood cell count and its classification were tested using Sysmex 2100.Troponin I（TNI）and B type of brain natriuretic peptide（BNP）were tested using Beckman DXI800.Blood glucose,blood lipids and myocardial enzymes were tested using Roche Cobas c701.Results White blood cell count（WBC）,neutrophil count（N）and the ratio of neutrophil to lymphocyte（NLR）were all increased in both STEMI group and NSTEMI group compared with control group.And these indices were also higher in STEMI group than those in NSTEMI group.The largest area under the curve of ROC curve（AUC ROC）was observed when N was used for diagnosis of STEMI（AUC=0.865;95% confidence interval 0.813-0.917）.Moreover,the ROC curve of combined N and TNI yields a larger AUC ROC than that of N and TNI being used individually（AUC=0.887 7;95% confidence interval 0.840 9-0.934 5）.Conclusion Neutrophil count has a high diagnostic value in ST segment elevation acute myocardial infarction,and it is very useful in the classification of acute myocardial infarction.