급성 심근경색증으로 재관류 치료를 시행받은 환자에서 내원시 백혈구 수와 심근 손상의 관계 = The Relationship between Initial Leukocyte Count and the Extent of Myocardial Injury in Patients with Acute Myocardial Infarction Who Received Reperfusion Therapy

다국어 초록 (Multilingual Abstract)

Background and Objectives：The presence of leukocytosis in patients with acute myocardial infarction (AMI) has been reported to be related to the extent of MI and with the prognosis. However, whether the leukocytosis itself is a cause or result of the myocardial injury has not been determined. The relationship between the leukocyte count and the extent of myocardial injury was investigated in patients with AMI that had undergone reperfusion therapy. Subjects and Methods：Patients with AMI that had undergone thrombolysis (n=60) or primary PCI (n=36) were included. The initial leukocyte counts were analyzed with regard to the peak and initial CK-MB levels. The relationship between leukocytosis and the time elapsed from the onset of symptoms, infarct related coronary arteries and the proximity of the lesions were also investigated. Results：In both groups, the initial leukocyte count did not show a significant relationship with the initial CK-MB level or the time elapsed from symptoms onset, which could be an indication of the extent of early myocardial injury. Furthermore, no significant relationship was shown with the infarct related coronary artery or proximity of the lesion. However, a relationship was shown with the maximum CK-MB level, which could be an indication of the extent of myocardial injury following reperfusion therapy in both groups (p<0.01). Conclusion：This study suggests that the initial leukocyte count in patients with AMI might is an important prognostic factor that determines the extent of myocardial injury following reperfusion therapy, rather than being a simple indicator of the extent of early myocardial injury.

국문 초록 (Abstract)

배경 및 목적：
급성 심근경색증 환자의 내원시 백혈구증가증은 심근경색의 크기와 양의 상관관계가 있으며, 환자의 불량한 예후와 연관이 있다고 알려져 있다. 그러나, 손상된 심근의 양이 많을수록 백혈구수가 증가하는지 혹은 증가된 백혈구가 더 큰 심근 손상을 유발하는지는 알려져 있지 않다. 본 연구는 급성 심근경색증으로 혈전용해치료를 시행 받은 환자와 관동맥중재술을 시행 받은 환자를 대상으로 응급실 내원 당시의 백혈구수와 재관류 치료 후의 심근 손상 정도와의 연관관계를 알아보고자 하였다.
방　법：
충북대병원 응급실을 방문하여 급성 심근경색증으로 진단 받은 환자 중 혈전용해치료(n=60) 혹은 관동맥중재술(n=36)을 시행 받은 환자들을 대상으로 하였다. 모든 환자들을 대상으로 내원시 말초혈액 백혈구수를 측정하였으며, 이를 증상 발현부터 응급실 내원시까지의 경과 시간, 내원시 Creatine Kinase(CK)-MB 수치, 재관류 치료 후 CK-MB의 최고치 및 상승치, 경색 관련 혈관 및 혈관 내 병변의 위치와 비교 분석하였다.
결　과：
혈전용해치료군과 관동맥중재술군 모두에서 내원시 백혈구수는 초기 심근 손상의 정도를 대변할 수 있는 내원시의 CK-MB 값 및 흉통의 발생부터 응급실에 도착할 때까지의 시간과는 유의한 상관관계가 없었고, 경색 관련 혈관 및 혈관 내 병변의 위치와도 유의한 상관관계를 보이지 않았다. 그러나, 양군 모두에서 내원시 백혈구수는 급성 심근경색증에 대한 재관류 치료 후의 심근 손상을 대변할 수 있는 입원 중 CK-MB의 최고치와 유의한 상관관계를 보였다(혈전용해치료군；r=0.34, p<0.01, 관동맥중재술군；r=0.45, p<0.01).
결　론：
급성 심근경색증 환자에서 응급실 내원시의 백혈구수는 초기 심근 손상의 정도에 의해 결정되는 단순한 변수라기보다는, 재관류 치료 후의 심근 손상의 정도를 결정하는 예후 인자중의 하나로 작용할 수도 있다고 생각된다.

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