中性粒细胞计数与急诊PCI术中无复流现象的关系研究

目的探讨急性心肌梗死患者入院中性粒细胞水平与急诊经皮冠脉介入治疗术后无复流现象的关系。方法入选接受急诊PCI治疗的急性心肌梗死患者150例,检测入院时中性粒细胞水平。依据入院时中性粒细胞水平结果将患者分为中性粒细胞未升高组(≤6.4×109/L)和中性粒细胞升高组(>6.4×109/L),根据PCI后冠脉造影血流速度分级,将患者分为冠脉血流正常组(TIMI分级=3)和无复流组(TIMI分级≤2),进一步比较组间临床特征的差异。采用多因素logistic回归分析入院中性粒细胞水平与无复流发生关系,以ROC曲线评估中性粒细胞计数预测无复流发生的诊断价值。结果中性粒细胞升高组患者中无复流的发生率明显高于中性粒细胞未升高组(33.3%vs.17.2%,P<0.05)。无复流组患者入院中性粒细胞水平明显高于冠脉血流正常组(7.9±4.3)×109/L vs.(6.2±3.0)×109/L,P=0.012]。多因素logistic回归发现入院中性粒细胞水平是急性心肌梗死急诊PCI术后冠脉造影无复流的独立危险因素(OR值=2.40,95%CI为1.18～5.15,P=0.023),但是ROC曲线分析表明入院中性粒细胞水平不能作为诊断无复流的单项检验指标。结论入院时中性粒细胞水平是急性心肌梗死急诊PCI术后冠脉造影无复流发生的独立危险因素,但是不能作为单一生物标记物用于预测无复流的发生。

The association of neutrophil counts and coronary no-reflow in patients undergoing emergency primary PCI

Objective The aim of this study was to investigate the relation between admission neutrophil counts and angiographic no-re？ow phenomenon in patients with acute myocardial infarction（AMI） after primary percutaneous coronary intervention（PCI）.Methods We conducted a retrospective analysis of data on 150 consecutive AMI patients who underwent primary PCl.Neutrophil counts were obtained at admission before PCI procedure.According to the neutrophil counts patients were divided into unelevated neutrophil counts（≤6.4×109/L） and elevated neutrophil counts（6.4×109/L） groups.The no-reflow phenomenon was defined as an angiographic outcome of thrombolysis in myocardial infarction（TIMI） Grade ≤2 without accompanying mechanical factors.Results Patients with elevated neutrophil counts on admission had higher incidence of no-re？ow phenomenon than those with unelevated neutrophil counts（33.3% vs.17.2%,P0.05）.Compared to normal reflow patients,no-reflow patients had a higher neutrophil counts（7.9±4.3×109/L vs.6.2±3.0×109/L,P=0.012）.Multivariate logistic regression analysis showed that elevated neutrophil counts on admission was the independent predictor of no-reflow（OR=2.40,95% CI：1.18~ 5.15,P=0.023）.At the receiver-operating characteristic curve,area under the curve was 0.616.Conclusion Neutrophil counts on admission was independently associated with the development of angiographic no-reflow phenomenon after primary PCI for AMI patients.However,neutrophil counts may not be good enough as a stand-alone biomarker for no-reflow phenomenon after primary PCI.