Kyne L, Hausdorff J M, Knight E, Dukas L, Azhar G, Wei J Y
Gerontology Division, Beth Israel Deaconess Medical Center, Division on Aging, Harvard Medical School, Boston, Massachusetts, USA.
Am Heart J. 2000 Jan;139(1 Pt 1):94-100. doi: 10.1016/s0002-8703(00)90314-4.
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 AMI between May 1 and Sept 30, 1996.
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 x10(9)/L on admission to the hospital; 65% had a neutrophil percentage >65%, and 61% had a lymphocyte percentage </=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).
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.
与急性心肌梗死（AMI）相关的炎症常表现为外周血白细胞增多和相对中性粒细胞增多。这一过程是否会导致梗死后充血性心力衰竭（CHF）的发生尚未明确。本研究的目的是探讨AMI患者入院时外周血白细胞总数和中性粒细胞百分比与随后发生CHF之间的关联。该研究设计为在一家三级转诊医院进行的回顾性队列研究。研究对象包括1996年5月1日至9月30日期间出院诊断为AMI的185例患者。
观察指标包括有确诊的胸部X线检查结果和/或收缩功能障碍的超声心动图证据的CHF临床发作。进行多变量逻辑回归分析，以检验AMI后前4天白细胞总数、中性粒细胞百分比与CHF发生之间的关系，同时控制基线特征和早期治疗干预措施。该队列中31%的患者入院时白细胞计数>11.0×10⁹/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%。该队列中43%的患者发生了CHF。其中，发生CHF的患者中有92.5%存在相对中性粒细胞增多（中性粒细胞百分比>65%），而未发生CHF的患者中这一比例为45%。多变量分析显示，相对中性粒细胞增多与随后发生CHF之间存在高度显著的关联（比值比14.3；95%置信区间5.2至39.3）。
AMI患者入院时相对中性粒细胞增多与CHF的早期发生显著相关。这种关联可能有助于识别高危个体，这些个体可能从更积极的干预措施中获益，以预防或降低CHF的风险。
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