白细胞计数对急性心肌梗死住院病死率的预测价值

目的探讨白细胞计数与急性心肌梗死患者临床特点和住院病死率之间的关系。方法收集首都医科大学宣武医院1993年~2005年初发急性ST段抬高心肌梗死患者资料,1056例患者按照白细胞计数>10×109/L和≤10×109/L分为2组,对2组临床特点、并发症和住院病死率进行比较。结果白细胞升高组平均年龄(61.3±12.7)岁较对照组〔(64.3±11.3)岁〕低,差异有统计学意义(P<0.001);CKMB(肌酸激酶MB同工酶)峰值〔分别为(2137.6±1543.4)IU/L和(1410.1±1183.9)IU/L〕,差异有统计学意义(P<0.001)、心源性休克(分别为6.0%和2.3%,P<0.01)和心律失常(分别为41.5%和29.4%,P<0.001)的发生率更高;住院病死率显著高于对照组(分别为136.%和7.6%,P<0.01)。Logistic回归显示WBC计数增高与住院死亡率相关。结论白细胞计数是预测心肌梗死短期预后的可靠指标。

Relationship between Baseline White Blood Cell Count and In-hospital Mortality in Patients with Acute Myocardial Infarction——The Value for Prediction of Prognosis

Objective To study the relationship between the white blood cell(WBC) count of peripheral blood at the early stage of acute myocardial infarction(AMI) and the prognosis.Methods One thousand and fifty-six cases of AMI were divided into normal WBC counting and elevated WBC counting groups(≤10×10⁹/L or >10×10⁹/L). Clinical characteristics of the two groups and in-hospital mortality were compared.Results The mean age of patients with leukocytosis was lower than that of the control〔(61.3±12.7) years and (64.3±11.3) years respectively, P<0.001〕; the peak value of MB isoenzyme of creatine kinase was higher in the group with elevated WBC count〔(2 137.6±1 543.4) IU/L and (1 410.1±1 183.9) respectively, P<0.001〕; the incidence of cardiogenic shock(6.0% and 2.3% respectively, P<0.01) and arrhythmias(41.5% and 29.4% respectively, P<0.001) were also higher in the WBC elevated group. WBC count was an independent predictor for in-hospital mortality by logistic regression analysis.Conclusion The WBC count is a valuable short-term predictor for in-hospital mortality patients with AMI.