急性心肌梗死患者的实验室指标特征分析

Characteristics of laboratory index in patients with acute myocardial infarction

目的 分析比较ST段抬高型心肌梗死(STEMI)、非ST段抬高型心肌梗死(NSTEMI)及健康人群的血细胞分类计数和生化指标差异,为研究急性心肌梗死(AMI)的病理生理机制提供理论依据。方法 选取2018年1月至2021年11月于四川大学华西医院急诊科就诊的AMI患者463例作为心梗组,其中STEMI组225例,NSTEMI组238例;筛选同一时期表观健康成年人139例作为对照组。比较3组人群的血细胞分析和生化指标的差异。结果 STEMI组、NSTEMI组的体质量指数均明显高于对照组(P<0.05),NSTEMI组高血压和糖尿病患病率均高于STEMI组(P<0.05)。心梗组白细胞计数(WBC)、中性粒细胞计数(NEUT)、单核细胞计数(MONO)水平均高于对照组(P<0.05),STEMI组上述指标高于NSTEMI组(P<0.05);与对照组相比,心梗组总胆固醇、总蛋白、清蛋白、红细胞计数(RBC)、血红蛋白(Hb)、血细胞比容(HCT)水平更低,其中,NSTEMI组RBC、Hb、HCT最低,对照组最高,差异均有统计学意义(P<0.05)。心梗组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、谷氨酰转肽酶、碱性磷酸酶、肌酸激酶、乳酸脱氢酶、羟丁酸脱氢酶水平较对照组更高(P<0.05)。结论 AMI,特别是NSTEMI,容易发生在有糖尿病、高血压等基础疾病的患者。AMI时血液中WBC、NEUT和MONO均显著升高,且STEMI比NSTEMI更高,说明炎症可能参与心肌梗死的发生、发展,且STEMI的炎性反应更强,提示抑制炎症可能对防治心肌梗死有重要意义。

Objective To analysis and compare the blood cell classification count and biochemical indexes among ST-elevation myocardial infarction(STEMI),non-ST-elevation myocardial infarction(NSTEMI) and healthy people, so as to provide theoretical basis for investigating the pathophysiological mechanism of acute myocardial infarction(AMI).Methods A total of 463 AMI patients admitted to the emergency department, West China Hospital of Sichuan University from January 2018 to November 2021 were selected as the AMI group, including 225 cases in STEMI group and 238 cases in NSTEMI group.A total of 139 apparently healthy adults were selected as control group.The differences in blood cell analysis and biochemical indexes among the 3 groups were compared.Results The body mass index of STEMI group and NSTEMI group were significantly higher than those of control group(P<0.05),and the prevalence of hypertension and diabetes in NSTEMI group were significantly higher than those in STEMI group(P<0.05).The levels of white blood cells count(WBC),neutrophils count(NEUT) and monocytes count(MONO) in AMI group were significantly higher than those of control group(P<0.05),and those in STEMI group were higher than those in NSTEMI group(P<0.05).Compared with the control group, the levels of total cholesterol, total protein, albumin, red cells count(RBC),hemoglobin(Hb),hematocrit(HCT) were lower in the AMI group, and the RBC,Hb and HCT were the lowest in the NSTEMI group and the highest in the control group, and the differences were statistically significant(P<0.05).The levels of alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, alkaline phosphatase, creatine kinase, lactate dehydrogenase and hydroxybutyrate dehydrogenase in AMI group were higher than those in control group(P<0.05).Conclusion AMI,especially NSTEMI,is prone to occur in patients with diabetes, hypertension and other underlying diseases.WBC,NEUT and MONO in the blood are significantly increased during AMI,and STEMI is higher than NSTEMI,indicating that inflammation is involved in the occurrence and development of myocardial infarction, and STEMI has a stronger inflammatory response, suggesting that inhibiting inflammation may have important significance in preventing myocardial infarction.