CAJ | 학술논문

目的：探讨全血细胞参数对40岁以下ST段抬高心肌梗死（ STEMI）的预测作用。方法回顾性分析2012年9月—2013年9月，因STEMI发作<6 h在北京安贞医院住院接受急诊经皮冠状动脉介入治疗（ PCI）、年龄<40岁的患者61例；入选同期因STEMI在北京安贞医院住院接受急诊PCI、年龄在45~70岁的患者以及门诊体检年龄<40岁的健康年轻人各61例，并对性别进行匹配，分别定义为年轻组、中老年组和对照组。记录年轻组和中老年组入院时和治疗3个月后的血常规及对照组血常规。结果年轻组与中老年组STEMI患者年龄、高血压患病率、糖尿病患病率、LDL-C比较，差异有统计学意义（ P<0.05）；对照组与年轻组的高血压患病率、吸烟率、冠心病家族史发生率、TG、HDL-C、空腹血糖（FBS）、糖化血红蛋白（HbA1c）比较，差异有统计学意义（P<0.05）。入院时年轻组STEMI患者白细胞计数（ WBC）和中性粒细胞计数高于中老年组（ P<0.05）；治疗3个月后两组血液学指标比较，差异均无统计学意义（P>0.05）。年轻组STEMI患者治疗3个月后WBC、中性粒细胞计数、淋巴细胞计数、中性粒细胞-淋巴细胞比（NLR）均高于对照组（P<0.05）。多因素Logistic逐步回归分析显示，吸烟〔OR=4.014，95%CI =（1.405，11.466），P =0.01〕和 WBC 升高〔OR =1.531，95%CI =（1.112，2.108），P =0.01〕是年轻人发生STEMI的独立危险因素，而HDL-C升高则是保护因素〔OR=0.002，95%CI =（0.000，0.027），P<0.001〕。WBC预测STEMI的受试者工作特征曲线（ ROC曲线）下面积为0.732〔95%CI=（0.636，0.829），P<0.001〕，最佳分界点为7.33×109/L，灵敏度为53%，特异度为87%。结论 WBC升高是年轻人发生STEMI的独立危险因素，对40岁以下年轻人发生STEMI有预测价值，为临床预测提供了参考价值。
목적：탐토전혈세포삼수대40세이하ST단태고심기경사（ STEMI）적예측작용。방법회고성분석2012년9월—2013년9월，인STEMI발작<6 h재북경안정의원주원접수급진경피관상동맥개입치료（ PCI）、년령<40세적환자61례；입선동기인STEMI재북경안정의원주원접수급진PCI、년령재45~70세적환자이급문진체검년령<40세적건강년경인각61례，병대성별진행필배，분별정의위년경조、중노년조화대조조。기록년경조화중노년조입원시화치료3개월후적혈상규급대조조혈상규。결과년경조여중노년조STEMI환자년령、고혈압환병솔、당뇨병환병솔、LDL-C비교，차이유통계학의의（ P<0.05）；대조조여년경조적고혈압환병솔、흡연솔、관심병가족사발생솔、TG、HDL-C、공복혈당（FBS）、당화혈홍단백（HbA1c）비교，차이유통계학의의（P<0.05）。입원시년경조STEMI환자백세포계수（ WBC）화중성립세포계수고우중노년조（ P<0.05）；치료3개월후량조혈액학지표비교，차이균무통계학의의（P>0.05）。년경조STEMI환자치료3개월후WBC、중성립세포계수、림파세포계수、중성립세포-림파세포비（NLR）균고우대조조（P<0.05）。다인소Logistic축보회귀분석현시，흡연〔OR=4.014，95%CI =（1.405，11.466），P =0.01〕화 WBC 승고〔OR =1.531，95%CI =（1.112，2.108），P =0.01〕시년경인발생STEMI적독립위험인소，이HDL-C승고칙시보호인소〔OR=0.002，95%CI =（0.000，0.027），P<0.001〕。WBC예측STEMI적수시자공작특정곡선（ ROC곡선）하면적위0.732〔95%CI=（0.636，0.829），P<0.001〕，최가분계점위7.33×109/L，령민도위53%，특이도위87%。결론 WBC승고시년경인발생STEMI적독립위험인소，대40세이하년경인발생STEMI유예측개치，위림상예측제공료삼고개치。
Objective To explore the prognostic value of hematologic parameters on young STEMI patients under 40 years old. Methods From September 2012 to September 2013,a total of 61 consecutive STEMI patients less than 40 year old who were admitted in Beijing Anzhen Hospital within 6 hours after symptom onset and received emergency percutaneous coronary intervention( PCI)were retrospectively analyzed. A total 61 patients between 45 to 70 year old with STEMI receiving the treatment of PCI at the same time and 61 healthy young patients under 40 year old matched with gender were separated into young group,ol-der group and placebo group. Hematologic parameters were measured at admission and 3 months after PCI in young and older pa-tients with STEMI. Results The differences of age,hypertension rate,diabetic mellitus rate and LDL-C between the young group and older group were significant(P<0. 05);hypertension rate,smoking rate,family history of coronary heart disease rate,TG,HDL-C、,FBS and HbA1c between the young group and placebo group were significantly different(P<0. 05). On admission,WBC and neutrophil count of young STEMI patients were higher than those of older ones( P <0. 05 );after three months' treatment,hematological parameters compare between the two groups showed no significant difference( P >0. 05 ). WBC,neutrophil count,lymphocyte count and NLR of young STEMI patients after 3 months' treatment were higher than those of placebo group( P <0. 05 ) . The multivariable logistic regression analysis showed that smoking〔OR =4. 014,95% CI =(1. 405,11. 466),P=0. 01〕and rise of WBC〔OR=1. 531,95%CI =(1. 112,2. 108),P=0. 01〕remained the inde-pendent risk factors for young STEMI,and rise of HDL-C〔OR=0. 002,95%CI =(0. 000,0. 027),P<0. 001〕was a protective factor. The optimal cut-off value of WBC was 7. 33 × 109/L,sensitivity was 53% and specificity was 87%. Conclu-sion The increasing of WBC is an independent risk factor and has predictive value for STEMI of young people under 40. The finding provides references for clinical prediction.