Neutrophilia and congestive heart failure after acute myocardial infarction
Neutrophilia and congestive heart failure after acute myocardial infarction
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DOI：
10.1016/s0002-8703(00)90314-4
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发表时间：
2000-01-01
影响因子：
4.8
通讯作者：
Wei, JY
中科院分区：
文献类型：
--
作者：
Kyne, L;Hausdorff, JM;Wei, JY
背景与急性心肌梗死(AMI)相关的炎症通常以外周血白细胞增多和相对中性粒细胞增多为特征。这一过程是否有助于脑梗塞后充血性心力衰竭(CHF)的发展尚不确定。本研究的目的是研究急性心肌梗死患者入院时外周血白细胞总数和中性粒细胞百分比与心力衰竭之间的关系。这项研究被设计为一项以三级转诊医院为背景的回溯性队列研究。受试者包括185名在1996年5月1日至9月30日期间被诊断为AM的出院患者。方法和结果测量包括CHF的临床表现和/或超声心动图证实的收缩功能障碍的结果。在控制基线特征和早期治疗干预的情况下，采用多变量Logistic回归分析研究急性心肌梗死后前4天白细胞总数、中性粒细胞百分比与心力衰竭发生的关系。31%的队列患者入院时白细胞计数<11.0×10(9)/L；65%的患者中性粒细胞百分比<65%，61%的患者淋巴细胞百分比<25%。队列中发生CHF的比例为43%。在这些人中，92.5%的人有相对的中性粒细胞减少(中性粒细胞百分比和65%)，而那些没有发生CHF的人中有45%。多变量分析显示，相对中性粒细胞增多与心力衰竭的发生有高度相关性(优势比14.3，95%可信区间5.2~39.3)。结论急性心肌梗死患者入院时的相对中性粒细胞增多与心力衰竭的早期发生密切相关。这种关联可能有助于识别高危人群，他们可能受益于更积极的干预措施，以预防或降低CHF的风险。
Background inflammation associated with acute myocardial infarction (AMI) is frequently marked by a peripheral leukocytosis and relative neutrophilia. Whether this process may contribute to the development of postinfarction congestive heart failure (CHF) is not established. The objective of this study was to examine the association between hospital admission peripheral total leukocyte count and the neutrophil percentage and the subsequent development of CHF in patients with AMI. The study was designed as a retrospective cohort study in the setting of a tertiary referral hospital. Participants included 185 patients discharged with a diagnosis of AM[ between May 1 and Sept 30, 1996.Methods and Results outcome measures included clinical episodes of CHF with confirmatory chest roentgenogram findings and/or echocardiographic evidence of contractile dysfunction. Multivariable logistic regression analyses were performed to examine the relation between the total leukocyte count, neutrophil percentage, and the development of CHF in the first 4 days after AMI while controlling for baseline characteristics and early therapeutic interventions. Thirty-one percent of the cohort had a leukocyte count >11.0 x 10(9)/L on admission to the hospital; 65% had a neutrophil percentage >65%, and 61% had a lymphocyte percentage less than or equal to 25%. CHF developed in 43% of the cohort. Of these, 92.5% had relative neutrophilia (neutrophil percentage >65%) compared with 45% of those in whom CHF did not develop. Multivariable analysis revealed a highly significant association between relative neutrophilia and the subsequent development of CHF (odds ratio 14.3; 95% confidence interval 5.2 to 39.3).Conclusions Relative neutrophilia on admission to the hospital in patients with AMI is significantly associated with the early development of CHF. This association may help in the identification of individuals at high risk who might benefit from more aggressive interventions to prevent or reduce the risk of CHF.