急诊经皮冠状动脉介入治疗术后中性粒细胞升高与预后的相关性

被引：2

作者：

何榕

杨振华

李海燕

郭丽君

张福春

牛杰

张永珍

王贵松

高炜

机构：

[1] 北京大学第三医院心内科

来源：

中华心血管病杂志 | 2009年 / 01期

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;

D O I：

暂无

中图分类号：

R686 [筋腱、韧带、滑囊疾病及损伤];

学科分类号：

1002 ; 100210 ;

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12 h内接受成功PCI的初发急性STEMI患者226例。PCI术前及术后2 h分别记录18导联心电图,PCI后12 h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30 d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30 d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。校正其他影响因素后,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),30 d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30 d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。

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