摘要
目的探讨经皮冠状动脉介入治疗（PCI）后中性粒细胞水平与急性ST段抬高心肌梗死（STEMI）患者近、远期预后的关系。方法连续入选发病12h内接受成功PCI的初发急性STEMI患者226例。PCI术前及术后2h分别记录18导联心电图，PCI后12h内进行中性粒细胞计数检测。采用logistic回归评价PCI后中性粒细胞水平与患者心电图ST段回落以及30d和2年内发生心脏不良事件的关系。采用Kaplan—Meier生存曲线分析不同中性粒细胞水平的患者30d和2年生存率的不同。结果所有患者PCI后的中性粒细胞计数在（2．83—18．74）×10^9／L，25百分位数、中位数及75百分位数分别为5．66×10^9／L、7．38×10^9／L和9．34×10^9／L。校止其他影响因素后，PCI后中性粒细胞计数每升高1×10^9／L，急性STEMI患者PCI后心电图ST段未回落的风险增加2．28倍（OR：2．28，P=0．009），30d内发生心力衰竭（OR：1．16，P=0．035）和死亡（OR：1．63，P=0．010）的风险分别增加1．16和1．63倍，2年内发生心力衰竭（OR：1．20，P=0．007）和死亡（OR：1．29，P=0．003）的风险分别增加1．20和1．29倍，而发生非致死性再次心肌梗死的风险无明显改变。PCI后中性粒细胞计数≥9．34×10^9／L的患者30d累积生存率（89．1％比99．1％比98．2％，P=0．010）和2年累积生存率（82．4％比96．1％比96．3％，P=0．003）明显低于（5．66～9．33）×10^9／L以及〈5．66×10^9／L的患者。结论PCI后中性粒细胞升高是初发急性STEMI患者成功PCI后近期和远期发生死亡和心力衰竭的独立预测因子。
Objective The aim of the study was to evaluate the prognostic value of the postprocedural neutrophil count in patients with first acute ST elevation myocardial infarction （STEMI） treated with successful primary percutaneous coronary intervention （PCI）. Methods A total of 226 consecutive STEMI patients underwent successful primary PCI were enrolled. Electrocardiograms were recorded before PCI and 2 hours after PCI. Neutrophil counts were measured within 12 hours after PCI. All patients were followed up for 2 years. Logistic regression analysis was used to evaluate predictive values of postprocedural neutrophil for ST-segment resolution （STR） after PCI and for death, non-fatal myocardial infarction and heart failure at 30 days and 2 years post PCI. Time-to-event analyses were performed using the Kaplan-Meier survival curves in patients with various ranges of postprocedural neutrophil counts. Results Postprocedural neutrophil count ranged from 2.83×10^9/L to 18.74 × 10^9/L, first quartile, median and fourth quartile were 5.66 ×10^9/L, 7.38× 10^9/L and 9.34 ×10^9/L respectively. Muhivariable logistic analysis showed that when postprocedural neutrophil count increased 1×10^9/L, the risk of non-STR increased 2. 28 fold （ OR： 2. 28, P =0. 009）, the risk of death （ OR： 1. 63, P =0. 010） and heart failure （ OR： 1.16, P = 0. 035 ） at 30 days increased 1.63 and 1.16 folds respectively, and the risk of death （ OR： 1.29, P =0. 003） and heart failure （OR： 1.20, P = 0. 007） at 2 years increased 1.29 and 1.20 folds respectively, but the risk of non-fatal myocardial infarction was not affected by postprocedural neutrophil count. Furthermore, the patients with postprocedural neutrophil count ≥ 9. 34 × 10^9/L had significant lower 30-day （89. 1% vs. 99. 1% vs. 98.2%, P=0.010） and 2-year（82.4% vs. 96. 1% vs. 96.3%, P= 0. 003） survival rates compared with the patients with postprocedural neutrophil count from 5.66× 10^9/L to 9. 33 ×10^9/L and the patients with postprocedura
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2009年第1期44-48,共5页
Chinese Journal of Cardiology
关键词
心肌梗死
血管成形术
经腔
经皮冠状动脉
中性白细胞
预后
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Neutrophils
Prognosis
