冠心病患者白细胞计数与临床分型的关系  

Relationship between white blood cell count and clinical classification in patients with coronary heart disease

作　　者：唐超慧 彭向 田进伟[1,2,3] 顾霞 TANG Chaohui;PENG Xiang;TIAN Jinwei;GU Xia(Department of Cardiology,the Second Affiliated Hospital of Harbin Medical University;The Key Laboratory of Myocardial Ischemia,Ministry of Education;The Key Laboratory of Panvascular Diseases,Harbin,Heilongjiang 150001,China)

机构地区：[1]哈尔滨医科大学附属第二医院心血管内科 [2]哈尔滨市心肌缺血教育部重点实验室 [3]黑龙江省泛血管疾病重点实验室,黑龙江省哈尔滨市150001

出　　处：《中国动脉硬化杂志》2024年第12期1051-1056,共6页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金青年基金项目(82100529)。

摘　　要：[目的]研究冠心病患者白细胞计数与其临床分型的关系及临床意义。[方法]入选2022年1月—2023年12月就诊于哈尔滨医科大学附属第二医院确诊为冠心病的患者301例作为研究对象,按临床表现、心电图检查等将其分为稳定型心绞痛(SAP)组和急性冠脉综合征(ACS)组,比较两组间一般资料、生物化学指标和心血管指标差异;采用Spearman相关分析白细胞计数、中性粒细胞计数与心血管相关指标,包括肌钙蛋白I、氨基末端脑钠肽前体(NT-proBNP)、射血分数、左心室舒张期末内径(LVEDD)、左心房内径、Gensini评分等的关系;采用ROC曲线确定白细胞计数诊断冠心病ACS和SAP分型的截断点,并以此截断点将患者分为白细胞正常水平组和白细胞高于正常水平组后比较两组间差异。[结果]ACS组高脂血症史、白细胞计数、中性粒细胞计数、C反应蛋白、血小板、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)、肌钙蛋白I、NT-proBNP、Gensini评分显著高于SAP组(均P<0.05),而ACS组阿司匹林、他汀类药物使用比例、射血分数低于SAP组(均P<0.05)。Spearman相关分析显示,白细胞计数与C反应蛋白(r=0.443,P<0.001)、肌钙蛋白I(r=0.333,P<0.001)、NT-proBNP(r=0.245,P<0.001)、Gensini评分(r=0.341,P<0.001)呈正相关,而与LVEDD(r=-0.212,P<0.001)呈负相关,中性粒细胞计数与C反应蛋白(r=0.430,P<0.001)、肌钙蛋白I(r=0.325,P<0.001)、NT-proBNP(r=0.292,P<0.001)、Gensini评分(r=0.353,P<0.001)呈正相关,而与LVEDD(r=-0.175,P=0.002)呈负相关。白细胞计数诊断ACS的截断点为9.35×10^(9)L^(-1)(灵敏度为56.7%,特异度为93.1%),以截断点为分界将患者分为白细胞正常水平组(n=202)和白细胞高于正常水平组(n=99);白细胞高于正常水平组患者的高脂血症、吸烟史、TC、LDLC、C反应蛋白、肌钙蛋白I、NT-proBNP、Gensini评分均显著高于白细胞正常水平组(均P<0.05),而LVEDD显著低于白细胞正常水平组(均P<0.05)Aim To study the relationship between white blood cell count and clinical classification in patients with coronary heart disease and its clinical significance.Methods A total of 301 patients diagnosed with coronary heart disease in the Second Affiliated Hospital of Harbin Medical University from January 2022 to December 2023 were selected as the research subjects,and divided into stable angina pectoris(SAP)group and acute coronary syndrome(ACS)group based on their clinical manifestations and results of electrocardiogram,the differences of general data,biochemical indexes and cardiovascular indexes between the two groups were compared.Spearman correlation analysis was used to analyze the relationship between white blood cell count,neutrophil count and cardiovascular related indicators,including troponin I,N-terminal pro-brain natriuretic peptide(NT-proBNP),ejection fraction,left ventricular end-diastolic diameter(LVEDD),left atrial diameter,Gensini score,etc.ROC curve was employed to determine the cut-off point for diagnosing ACS and SAP classification of coronary heart disease based on white blood cell count,and dividing patients into a group with normal white blood cell level and a group with above normal white blood cell level based on this cut-off point,the differences between the two groups were compared.Results The ratio of hyperlipidaemia history,white blood cell count,neutrophil count,C-reactive protein,platelet count,total cholesterol(TC),low density lipoprotein cholesterol(LDLC),troponin I,NT-proBNP and Gensini score in the ACS group were significantly higher than those in the SAP group(all P<0.05),while the ratio of aspirin use,the ratio of statin use,and ejection fraction in the ACS group were lower than those in the SAP group(all P<0.05).Spearman correlation analysis results showed that white blood cell count was positively correlated with C-reactive protein(r=0.443,P<0.001),troponin I(r=0.333,P<0.001),NT-proBNP(r=0.245,P<0.001)and Gensini score(r=0.341,P<0.001),but negatively correlated with LVEDD(r=

关 键 词：冠心病 白细胞计数 急性冠脉综合征 稳定型心绞痛 

分 类 号：R5[医药卫生—内科学]