Barron H V, Cannon C P, Murphy S A, Braunwald E, Gibson C M
Cardiovascular Division, Department of Medicine, University of California San Francisco, USA.
Circulation. 2000 Nov 7;102(19):2329-34. doi: 10.1161/01.cir.102.19.2329.
Elevation of the white blood cell (WBC) count during acute myocardial infarction (AMI) is associated with adverse outcomes. We examined the relationship between the WBC count and angiographic findings to gain insight into this relationship. Results and Methods-We evaluated data from 975 patients in the Thrombolysis In Myocardial Infarction (TIMI) 10A and 10B trials. Patients with a closed artery at 60 and 90 minutes had higher a WBC count than patients with an open artery (P:=0.02). Likewise, the presence of angiographically apparent thrombus was associated with a higher WBC count (11.5+/-5.2x10(9)/L, n=290, versus 10.7+/-3. 5x10(9)/L, n=648; P=0.008). In addition, a higher WBC count was associated with poorer TIMI myocardial perfusion grades (4-way P=0.04). Mortality rates were higher in patients with a higher WBC count (0% for WBC count 0 to 5x10(9)/L, 4.9% for WBC count 5 to 10x10(9)/L, 3.8% for WBC count 10 to 15x10(9)/L, 10.4% for WBC count >15x10(9)/L; P=0.03). The development of new congestive heart failure or shock was also associated with a higher WBC count (0% for WBC count 0 to 5x10(9)/L, 5.2% for WBC count 5 to 10x10(9)/L, 6.1% for WBC count 10 to 15x10(9)/L, 17.1% for WBC count >15x10(9)/L; P<0.001), an observation that remained significant in a multivariable model that adjusted for potential confounding variables (odds ratio 1.21, P=0.002).
Elevation in WBC count was associated with reduced epicardial blood flow and myocardial perfusion, thromboresistance (arteries open later and have a greater thrombus burden), and a higher incidence of new congestive heart failure and death. These observations provide a potential explanation for the higher mortality rate observed among AMI patients with elevated WBC counts and helps explain the growing body of literature that links inflammation and cardiovascular disease.
急性心肌梗死（AMI）期间白细胞（WBC）计数升高与不良预后相关。我们研究了WBC计数与血管造影结果之间的关系，以深入了解这种关系。结果与方法——我们评估了心肌梗死溶栓（TIMI）10A和10B试验中975例患者的数据。在60分钟和90分钟时动脉闭塞的患者WBC计数高于动脉开放的患者（P = 0.02）。同样，血管造影显示有血栓与较高的WBC计数相关（11.5±5.2×10⁹/L，n = 290，对比10.7±3.5×10⁹/L，n = 648；P = 0.008）。此外，较高的WBC计数与较差的TIMI心肌灌注分级相关（四分位P = 0.04）。WBC计数较高的患者死亡率更高（WBC计数0至5×10⁹/L为0%，WBC计数5至10×10⁹/L为4.9%，WBC计数10至15×10⁹/L为3.8%，WBC计数>15×10⁹/L为10.4%；P = 0.03）。新发充血性心力衰竭或休克的发生也与较高的WBC计数相关（WBC计数0至5×10⁹/L为0%，WBC计数5至10×10⁹/L为5.2%，WBC计数10至15×10⁹/L为6.1%，WBC计数>15×10⁹/L为17.1%；P<0.001），在调整了潜在混杂变量的多变量模型中这一观察结果仍具有显著性（比值比1.21，P = 0.002）。
WBC计数升高与心外膜血流和心肌灌注减少、血栓抵抗（动脉开放较晚且血栓负荷更大）以及新发充血性心力衰竭和死亡的发生率较高相关。这些观察结果为WBC计数升高的AMI患者中观察到的较高死亡率提供了一个潜在解释，并有助于解释将炎症与心血管疾病联系起来的越来越多的文献。
