外周血白细胞计数对急性心肌梗死心力衰竭的预测作用

Prognostic significance of peripheral leukocyte count for heart failure after acute myocardial infarction

目的 了解急性心肌梗死 (AMI)患者入院时外周血白细胞 (WBC)及中性粒细胞 (NER)计数是否与住院期心衰和死亡事件以及随访期的死亡事件有相关性。方法 对 2 0 0 0年 1月 1日～ 2 0 0 1年 12月 31日收治的因AMI住进冠心病监护病房的 12 3例患者于入院时立即取外周血查血常规 ,并连续观察其住院期和随访期的临床结果 ,分析WBC和NER与心衰及死亡事件的相关性及预测价值。结果 心衰组患者WBC计数 (P =0 0 0 3)及NER绝对值 (P =0 0 0 4 )明显高于非心衰组患者 ,而NER %两组间无显著差异 (P =0 0 94 ) ,WBC计数 (r =0 314 ,P <0 0 0 1)及NER绝对值 (r =0 2 6 1,P =0 0 0 4 )与心衰的发生呈正相关 ,而NER %与心衰发生无明显相关性 (r =0 14 9,P =0 10 0 )。WBC计数 >11 0× 10 9/L(χ2 =4 0 0 7,P =0 0 31,OR =0 2 35 ,CI=0 0 5 8～ 0 95 8)以及NER绝对值 >12 0× 10 9/L(χ2 =4 6 14 ,P =0 0 32 ,OR =2 36 1,CI=0 4 6 9～ 11 895 )为心衰的独立预测因素。住院期和随访期死亡组WBC、NER、NER %均大于非死亡组 ,但差别无统计学意义。结论 本研究证明 ,AMI发病后 6h内WBC和NER增加与住院期心力衰竭发生有关 ,是相对简单易行的预测AMI发生心衰的指标 ,NER绝对值较NER %敏感性高。

Objective The aim was to examine the correlations between hospital admission peripheral total leukocyte count, neutrophil count and percentage and the subsequent developing heart failure in patients with AMI. Methods The total 123 patients with AMI were studied. Leukocyte count, neutrophil count and percentage of neutrophil were measured on hospital admission. We assessed the correlations between peripheral leukocyte count, neutrophil count and percentage and clinical prognosis including heart failure, mortality during hospital and follow-up periods. Results The patients with inhospital heart failure had higher leukocyte count (P=0.003) and neutrophil count (P=0.004) than those without the complication. There was no significant difference of neutrophil percentage between heart failure and non-heart failure group. Leukocyte count (r=0 314,P<0.001) and neutrophil count (r=0 261,P=0.004) were positively correlated with inhospital heart failure. Multivariate analyses showed that leukocyte count >11 0×10 9/L(χ 2=4 007,P=0 031,OR=0 235,CI=0 058～0 958) and neutrophil count>12.0×10 9/L(χ 2=4 614,P=0 032,OR=2 361,CI=0 469～11 895) were the independent predictors of inhospital heart failure. Conclusion Peripheral leukocyte count and neutrophil count were the independent predictors of heart failure, suggesting a possible role of neutrophil in the development of myocardium necrosis and heart failure and also suggesting it was possible to reduce the size of necrotic myocardium and development of heart failure after AMI by limiting the infiltration of neutrophils into ischemic myocardium.