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目的研究急性心肌梗死斑块破裂光学相干断层成像(OCT)特征与外周血白细胞计数的关系。方法连续入选阜外医院因急性心肌梗死(AMI)行急诊经皮冠状动脉介入治疗(PCI)并在血栓抽吸后行OCT证实斑块破裂的33例患者。搜集患者人口学资料、危险因素、既往病史、冠状动脉造影资料、OCT影像特征和围术期实验室检查结果。结果 33例患者中,纤维帽厚度>65μm患者淋巴细胞计数、单核细胞计数和嗜碱性粒细胞计数[(2.31±0.86)×10~9/L比(1.57±0.80)×10~9/L;(0.57±0.08)×10~9/L比(0.44±0.14)×10~9/L;(0.05±0.03)×10~9/L比(0.03±0.02)×10~9/L]明显高于纤维帽厚度≤65μm患者,差异均有统计学意义(均P<0.05)。有胆固醇结晶组嗜酸性粒细胞计数低于无胆固醇结晶患者[(0.04±0.06)×10~9/L比(0.10±0.09)×109/L,P=0.028];前者的中性粒细胞/淋巴细胞比值显著高于后者[(8.35±6.13)比(4.97±2.01),P=0.020]。具有白血栓的患者淋巴细胞计数高于无白血栓组(P=0.038)。钙化斑块患者单核细胞计数明显高于无钙化斑块患者(P<0.05)。有巨噬细胞浸润患者血小板/淋巴细胞比值明显升高[(165.72±85.93)比(113.47±19.13),P<0.05)]。OCT特征数量的增加,白细胞计数、中性粒细胞计数、单核细胞计数水平逐渐升高,但仅单核细胞计数水平的升高差异有统计学意义(P=0.014)。结论外周血白细胞计数水平可能与AMI患者斑块破裂的OCT特征有关,提示炎症水平与斑块破裂有关。
Objective To investigate the relationship between the characteristics of plaque rupture optical coherence tomography (OCT) and peripheral white blood cell count in acute myocardial infarction. Methods A total of 33 consecutive patients with plaque rupture were enrolled in the Fu Wai Hospital undergoing emergency percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and underwent OCT after thrombus aspiration. Collected demographic data, risk factors, past medical history, coronary angiography data, OCT imaging features and perioperative laboratory test results. Results Among the 33 patients, the lymphocyte count, monocyte count and basophil count [(2.31 ± 0.86) × 10 ~ 9 / L (1.57 ± 0.80) × 10 ~ 9 / L; (0.57 ± 0.08) × 10 ~ 9 / L ratio (0.44 ± 0.14) × 10 ~ 9 / L; (0.03 ± 0.02) × 10 ~ 9 / L; Significantly higher than the fiber cap thickness ≤ 65μm patients, the differences were statistically significant (P <0.05). The number of eosinophils in patients with cholesterol crystals was significantly lower than those in patients without cholesterol crystals [(0.04 ± 0.06) × 10 ~ 9 / L (0.10 ± 0.09) × 109 / L, P = 0.028] Lymphocyte ratio was significantly higher than the latter [(8.35 ± 6.13) vs (4.97 ± 2.01), P = 0.020]. Patients with white blood clots had higher lymphocyte counts than those without white thrombosis (P = 0.038). Patients with calcified plaque had a significantly higher monocyte count than those without plaque (P <0.05). In patients with macrophage infiltration, the ratio of platelet / lymphocyte was significantly increased (165.72 ± 85.93 vs 113.47 ± 19.13, P <0.05). The number of OCT increased, the white blood cell count, neutrophil count and monocyte count increased gradually. However, the increase of monocyte count was only statistically significant (P = 0.014). Conclusion The peripheral blood leukocyte count may be related to the OCT features of plaque rupture in patients with AMI, suggesting that the level of inflammation is related to plaque rupture.