Neutrophil Counts Help Predict Free Wall Rupture Following St-elevation Myocardial Infarction.
Neutrophil Counts Help Predict Free Wall Rupture Following St-elevation Myocardial Infarction.
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DOI：
10.25011/cim.v44i2.36273
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发表时间：
2021-06
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影响因子：
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通讯作者：
W. Gong;Siyi Li;Yan Yan-Yan;H. Ai;Xiao Wang;Guanqi Zhao;Xin Huang;Ruifeng Gu;S. Nie
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文献类型：
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作者：
W. Gong;Siyi Li;Yan Yan-Yan;H. Ai;Xiao Wang;Guanqi Zhao;Xin Huang;Ruifeng Gu;S. Nie
游离壁破裂（FWR）是急性心肌梗死后的一种致死性并发症，但其发生机制尚不清楚。本研究分析中性粒细胞计数与ST段抬高心肌梗死（STEMI）后FWR的关系。方法病例组为伴FWR的STEMI患者，对照组为不伴FWR的STEMI患者，病例对照比为1：4。回顾性分析患者的人口学资料、临床表现及实验室检查结果。结果在总共6,712例连续STEMI患者中，78例患者（1.2%）有FWR。与STEMI患者相比，FWR患者年龄更大，更可能是女性前壁梗死。FWR组的白色血细胞（WBC）计数显著较高。此外，我们发现中性粒细胞计数升高主要是白细胞计数升高的原因。年龄与中性粒细胞计数之间也存在相关性（P=0.0109）;随着患者年龄的增加，中性粒细胞计数降低（P=0.0387）。我们还发现中性粒细胞计数与心肌梗死发作和FWR之间的时间无相关性;然而，当将这些患者分为因STEMI入院后FWR ≤48 h和FWR >48 h时，中性粒细胞计数有显著差异（P=0.0196）。Logistic回归分析结果显示，中性粒细胞增多是FWR的独立危险因素（OR：2.404，可信区间：1.055-5.477）。结论中性粒细胞计数升高是FWR与STEMI患者WBC计数差异的主要原因。中性粒细胞升高是FWR的独立危险因素。本研究为进一步研究和开发预防FWR的治疗药物提供了线索。
PURPOSE Free wall rupture (FWR) is a lethal complication after acute myocardial infarction; however, the un-derlying mechanisms of FWR are unclear. This study analyzes the relationship between neutrophil counts and FWR following ST-elevation myocardial infarction (STEMI). METHODS The case group was STEMI patients with FWR and the control group was STEMI patients without FWR (case-control ratio was 1:4). The demographic data, clinical manifestation and laboratory test results were retrospectively collected and analyzed. RESULTS Of a total of 6,712 consecutive STEMI patients, 78 patients (1.2%) had FWR. Compared with STEMI patients, patients with FWR were older and more likely to be female with an anterior infarct. White blood cell (WBC) counts were significantly higher in the FWR group. Moreover, we found that the elevated neutrophil counts mainly accounted for the elevated WBC counts. There was also a correlation between the age and neu-trophil counts (P=0.0109); as patient age increased, neutrophil counts decreased (P=0.0387). We also found no correlation between neutrophil counts and the time between myocardial infarction attack and FWR; however, when dividing these patients into FWR ≤48 h after admission to hospital for STEMI and FWR >48 h, there was a significant difference in neutrophil counts (P=0.0196). Furthermore, the results of logistic regression analy-sis showed that increased neutrophil was an independent risk factor for FWR (odds ratio: 2.404, confidence interval: 1.055-5.477). CONCLUSION Elevated neutrophil counts were found to be the main cause of differences in WBC counts be-tween FWR and STEMI. Elevated neutrophil was an independent risk factor for FWR. This study provided clues for further research and development of therapeutics for the prevention of FWR.