Department of Medicine, Akershus University Hospital, University of Oslo, Sykehusvn 25, Lørenskog 1478, Norway.
Heart. 2013 Jan;99(2):122-6. doi: 10.1136/heartjnl-2012-302685. Epub 2012 Sep 28.
To investigate if acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with myocardial injury, expressed as elevated high sensitive cardiac troponin T (hs-cTnT), and to identify determinants of hs-cTnT in chronic obstructive pulmonary disease (COPD) patients.
In a cross-sectional study, hs-cTnT in patients hospitalised for AECOPD was compared with hs-cTnT in COPD patients in their stable state.
The study was conducted at a teaching and a pulmonary rehabilitation clinic.
Consecutive admissions to participating units for the years 2010-2011 meeting objective, standardised criteria for AECOPD and stable COPD.
Ratio of hs-cTnT in hospitalised AECOPD patients compared with stable COPD patients. Change in the ratio of hs-cTnT per unit increase of relevant covariables.
The geometric mean of hs-cTnT in the index group was 25.8 ng/l (95% CI 21.1 to 31.7) compared with 4.55 ng/l (95% CI 3.72 to 5.67) in the reference group. After inclusion of relevant covariables, multiple linear regression analyses showed that the ratio between hs-cTnT in AECOPD patients and the references was 4.26 (95% CI 3.02 to 6.00) and that hs-cTnT increased 1.41-fold (95% CI 1.20 to 1.68), for each quartile increase in leucocyte count in stable COPD but not in AECOPD. Higher hs-cTnT levels were also associated with the presence of pathological q-waves (p=0.012) and electrocardiographic left ventricular hypertrophy (p=0.039), long-term oxygen treatment (p=0.002) and decreasing forced expiratory volume in 1 s (p=0.014). A significant univariable association between cTnT and arterial hypoxaemia was also found but this association was attenuated almost to a zero effect after inclusion of relevant covariates.
AECOPD is associated with higher hs-cTnT as compared with stable COPD. In stable COPD, hs-cTnT appears to be positively associated with indices of COPD severity, whereas we were unable to identify significant determinants of hs-cTnT in AECOPD.
探讨慢性阻塞性肺疾病（COPD）急性加重（AECOPD）是否与心肌损伤有关，表现为高敏心肌肌钙蛋白 T（hs-cTnT）升高，并确定 COPD 患者 hs-cTnT 的决定因素。
在一项横断面研究中，比较了因 AECOPD 住院的患者与处于稳定状态的 COPD 患者的 hs-cTnT。
该研究在一家教学医院和一家肺康复诊所进行。
连续入住参与单位的患者在 2010 年至 2011 年期间符合 AECOPD 和稳定 COPD 的客观、标准化标准。
住院 AECOPD 患者与稳定 COPD 患者的 hs-cTnT 比值。hs-cTnT 比值随相关协变量单位增加而变化。
指数组 hs-cTnT 的几何平均值为 25.8ng/L（95%CI 21.1 至 31.7），而对照组为 4.55ng/L（95%CI 3.72 至 5.67）。纳入相关协变量后，多元线性回归分析显示，AECOPD 患者与对照组的 hs-cTnT 比值为 4.26（95%CI 3.02 至 6.00），hs-cTnT 增加 1.41 倍（95%CI 1.20 至 1.68），稳定 COPD 中白细胞计数每增加一个四分位数，但在 AECOPD 中则不然。hs-cTnT 水平升高也与病理性 q 波的存在（p=0.012）、心电图左心室肥厚（p=0.039）、长期氧疗（p=0.002）和用力呼气量 1 秒率下降（p=0.014）有关。还发现 cTnT 与动脉低氧血症之间存在显著的单变量关联，但纳入相关协变量后，这种关联几乎减弱至零效应。
AECOPD 与稳定 COPD 相比，hs-cTnT 升高。在稳定的 COPD 中，hs-cTnT 似乎与 COPD 严重程度指数呈正相关，而我们未能确定 AECOPD 中 hs-cTnT 的显著决定因素。
