Brekke Pål H, Omland Torbjørn, Holmedal Stein Harald, Smith Pål, Søyseth Vidar
Department of Medicine, Akershus University Hospital, Lørenskog, Norway.
BMC Pulm Med. 2009 Jul 19;9:35. doi: 10.1186/1471-2466-9-35.
Cardiac Troponin T (cTnT) elevation during exacerbations of chronic obstructive pulmonary disease (COPD) is associated with increased mortality the first year after hospital discharge. The factors associated with cTnT elevation in COPD are not known.
From our hospital's database, all patients admitted with COPD exacerbation in 2000-03 were identified. 441 had measurement of cTnT performed. Levels of cTnT > or = 0.04 microg/l were considered elevated. Clinical and historical data were retrieved from patient records, hospital and laboratory databases. Odds ratios for cTnT elevation were calculated using logistic regression.
120 patients (27%) had elevated cTnT levels. The covariates independently associated with elevated cTnT were increasing neutrophil count, creatinine concentration, heart rate and Cardiac Infarction Injury Score (CIIS), and decreasing hemoglobin concentration. The adjusted odds ratios (95% confidence intervals in parentheses) for cTnT elevation were 1.52 (1.20-1.94) for a 5 x 106/ml increase in neutrophils, 1.21 (1.12-1.32) for a 10 micromol/l increase in creatinine, 0.80 (0.69-0.92) for a 1 mg/dl increase in hemoglobin, 1.24 (1.09-1.42) for a 10 beats/minute increase in heart rate and 1.44 (1.15-1.82) for a 10 point increase in CIIS.
Multiple factors are associated with cTnT elevation, probably reflecting the wide panorama of comorbid conditions typically seen in COPD. The positive association between neutrophils and cTnT elevation is compatible with the concept that an exaggerated inflammatory response in COPD exacerbation may predispose for myocardial injury.
慢性阻塞性肺疾病（COPD）急性加重期心肌肌钙蛋白T（cTnT）升高与出院后第一年死亡率增加相关。COPD患者cTnT升高的相关因素尚不清楚。
从我院数据库中识别出2000 - 2003年因COPD急性加重入院的所有患者。441例患者检测了cTnT。cTnT水平≥0.04μg/l被视为升高。从患者病历、医院和实验室数据库中检索临床和病史资料。使用逻辑回归计算cTnT升高的比值比。
120例患者（27%）cTnT水平升高。与cTnT升高独立相关的协变量包括中性粒细胞计数增加、肌酐浓度、心率和心肌梗死损伤评分（CIIS）增加，以及血红蛋白浓度降低。中性粒细胞每增加5×10⁶/ml，cTnT升高的调整后比值比（括号内为95%置信区间）为1.52（1.20 - 1.94）；肌酐每增加10μmol/l为1.21（1.12 - 1.32）；血红蛋白每增加1mg/dl为0.80（0.69 - 0.92）；心率每增加10次/分钟为1.24（1.09 - 1.42）；CIIS每增加10分为1.44（1.15 - 1.82）。
多种因素与cTnT升高相关，这可能反映了COPD患者常见的广泛合并症情况。中性粒细胞与cTnT升高之间的正相关与COPD急性加重期过度炎症反应可能导致心肌损伤的概念相符。
