Kirtane Ajay J, Bui Anh, Murphy Sabina A, Barron Hal V, Gibson C Michael
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Am J Cardiol. 2004 Mar 1;93(5):532-6. doi: 10.1016/j.amjcard.2003.11.013.
We hypothesized that absolute and relative neutrophilia would be associated with adverse angiographic outcomes in the 394 patient Limitation of Myocardial Infarction Following Thrombolysis in Acute Myocardial Infarction (LIMIT) Acute Myocardial Infarction (AMI) trial of fibrinolysis in ST-elevation myocardial infarction. The mean neutrophil count was 7.9 x 10(9)/L, with a mean neutrophil percentage of 72%. Patients with time from symptom onset to fibrinolytic treatment more than the median (2.7 hours) had a higher neutrophil count and percentage of neutrophils than patients with shorter time to treatment. Patients with a closed infarct-related artery at 90 minutes (Thrombolysis In Myocardial Infarction [TIMI] grade 0/1 flow) had higher neutrophil counts (8.8 +/- 3.8 vs 7.6 +/- 3.0, p = 0.02) but no difference in the percentage of neutrophils than patients with an open artery. Higher neutrophil counts were also mildly correlated with longer corrected TIMI frame counts (CTFC) in the infarct-related artery (r = 0.14, p = 0.02). Patients with impaired myocardial perfusion by TIMI myocardial perfusion grade (TMPG) had a greater percentage of neutrophils (73.2 +/- 10.7% for TMPG 0/1 vs 69.9 +/- 12.6% for TMPG 2/3, p = 0.047) but no detectable difference in neutrophil counts (8.2 +/- 3.3 vs 7.7 +/- 2.9, p = 0.24). There were no significant associations between other indexes in the cell differential and angiographic or clinical outcomes. Higher neutrophil counts remained independently associated with both closed arteries and CTFC in multivariable models controlling for age, left anterior descending artery infarct location, time to treatment, and pulse and blood pressure on admission. A greater percentage of neutrophils remained independently associated with impaired microvascular perfusion in a similar multivariable model. In patients with ST-elevation myocardial infarction, absolute and relative neutrophilia were associated with impaired epicardial and microvascular perfusion.
我们假设，在急性心肌梗死溶栓治疗后心肌梗死范围限制（LIMIT）急性心肌梗死（AMI）试验的394例患者中，绝对和相对中性粒细胞增多与血管造影不良结果相关。该试验旨在研究ST段抬高型心肌梗死的溶栓治疗。中性粒细胞计数的平均值为7.9×10⁹/L，中性粒细胞百分比的平均值为72%。症状发作至溶栓治疗时间超过中位数（2.7小时）的患者，其中性粒细胞计数和中性粒细胞百分比高于治疗时间较短的患者。90分钟时梗死相关动脉闭塞的患者（心肌梗死溶栓治疗[TIMI]0/1级血流）中性粒细胞计数较高（8.8±3.8对7.6±3.0，p=0.02），但中性粒细胞百分比与动脉通畅的患者无差异。较高的中性粒细胞计数也与梗死相关动脉中较长的校正TIMI帧计数（CTFC）轻度相关（r=0.14，p=0.02）。TIMI心肌灌注分级（TMPG）提示心肌灌注受损的患者中性粒细胞百分比更高（TMPG 0/1为73.2±10.7%，TMPG 2/3为69.9±12.6%，p=0.047），但中性粒细胞计数无明显差异（8.2±3.3对7.7±2.9，p=0.24）。细胞分类中的其他指标与血管造影或临床结果之间无显著关联。在控制年龄、左前降支梗死部位、治疗时间以及入院时脉搏和血压的多变量模型中，较高的中性粒细胞计数仍然与动脉闭塞和CTFC独立相关。在类似的多变量模型中，较高的中性粒细胞百分比仍然与微血管灌注受损独立相关。在ST段抬高型心肌梗死患者中，绝对和相对中性粒细胞增多与心外膜和微血管灌注受损相关。
