白细胞预测急性心肌梗死患者院内死亡的临床价值

Clinical Value of White Blood Cells in Predicting In-hospital Death in Patients with Acute Myocardial Infarction

目的探讨白细胞预测急性心肌梗死(AMI)患者院内死亡的临床价值。方法回顾性分析2014年1月-2022年10月我院接受治疗的AMI患者507例,根据白细胞数量分为A组[白细胞数量(4~10)×10^(9)/L]和B组(白细胞数量>10×10^(9)/L),比较两组一般资料、院内病死率,并采用COX回归分析AMI患者死亡的预测因素。结果两组白细胞数量、年龄、EF值、吸烟、术后他汀、服用血管活性药、MACE结果比较,差异有统计学意义(P<0.05);A组院内病死率为7.89‰,低于B组的92.70‰,差异有统计学意义(P<0.05)。白细胞、中性粒细胞、年龄、心衰、血管活性药物是影响AMI患者死亡的独立因素,即白细胞高是白细胞正常发生死亡概率的0.993倍,中性粒细胞高是中性粒细胞正常的1.052倍,年龄大是年龄小的1.060倍,发生心衰是不发生心衰的4.423倍,不使用血管活性药是使用血管活性药物的0.282倍。结论白细胞、中性粒细胞、年龄、心衰、血管活性药物是AMI死亡的预测因素,应用白细胞计数对患者结局的预测可以有助于临床决策。

Objective To investigate the clinical value of white blood cells in predicting in-hospital death in patients with acute myocardial infarction(AMI).Methods A total of 507 patients with AMI who were treated in our hospital from January 2014 to October 2022 were retrospectively analyzed.According to the number of white blood cells,they were divided into group A[white blood cell count(4-10)×10^(9)/L]and group B(white blood cell count>10×10^(9)/L).The general data and in-hospital mortality were compared between the two groups.COX regression was used to analyze the predictors of death in AMI patients.Results There were significant differences in the number of white blood cells,age,EF value,smoking,postoperative statins,taking vasoactive drugs and MACE results between the two groups(P<0.05).The in-hospital mortality of group A was 7.89‰,which was lower than 92.70‰of group B,and the difference was statistically significant(P<0.05).White blood cells,neutrophils,age,heart failure,and vasoactive drugs are independent factors affecting the death of AMI patients,that was,the high white blood cell count was 0.993 times than of the death probability of normal white blood cell count,high neutrophils was 1.052 times than of the normal neutrophils,older was 1.060 times younger,and heart failure was 4.423 times than of the absence of heart failure,the non-use of vasoactive drugs was 0.282 times that of vasoactive drugs.Conclusion White blood cells,neutrophils,age,heart failure,and vasoactive drugs are predictors of AMI death.The application of white blood cell count to predict the outcome of patients can help clinical decision-making.