Department of Sports Medicine, Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland.
Respiration. 2013;85(3):195-202. doi: 10.1159/000345218. Epub 2012 Dec 19.
The prevalence of cardiovascular mortality is high in Chronic Obstructive Pulmonary Disease (COPD) and the identification of clinical parameters to improve risk stratification is of great interest.
This study aims to assess the predictive strength of daily walking activity on expression of cardiac biomarkers in patients with COPD.
One hundred and five patients with COPD (66.1 ± 8.7 years of age) were prospectively analyzed. Daily walking activity was measured by means of accelerometry. Stepwise multivariate regression analyses were employed with either midregional proatrial natriuretic peptide (MRproANP) or plasma proadrenomedullin (MRproADM) as dependent variables, and age, age-adjusted Charlson score, Modified Medical Research Council Dyspnea Scale (MMRC), Saint Georges Respiratory Questionnaire total score and either total walk, steps per day or fast walk as covariates.
Independent predictors of MRproANP included age (p = 0.015) and either total walk or steps per day (both p < 0.0001). Total walk or steps per day were the only independent predictors of MRproADM (p < 0.0001). There was a significant negative correlation between fast walk and MMRC (R = -0.70; p < 0.001) and fast walk was only independently predictive of MRproANP but not MRproADM once MMRC was excluded from the list of covariates (p = 0.023 and p = 0.057, respectively).
Daily walking activity independently predicts levels of circulating MRproANP and MRproADM in stable COPD patients, two prognostic biomarkers of cardiac distress associated with long-term survival upon exacerbation of COPD. Employing activity monitors in the stable state might simplify risk stratification in daily living.
慢性阻塞性肺疾病（COPD）患者心血管死亡率较高，寻找可改善风险分层的临床参数具有重要意义。
本研究旨在评估 COPD 患者日常步行活动对心脏生物标志物表达的预测能力。
前瞻性分析 105 例 COPD 患者（66.1±8.7 岁）。采用加速度计测量日常步行活动。逐步多元回归分析以中区域前利尿钠肽（MRproANP）或血浆促肾上腺髓质素（MRproADM）为因变量，年龄、年龄调整 Charlson 评分、改良医学研究委员会呼吸困难量表（MMRC）、圣乔治呼吸问卷总分和总步行、每日步数或快走作为协变量。
MRproANP 的独立预测因素包括年龄（p=0.015）和总步行或每日步数（均 p<0.0001）。总步行或每日步数是 MRproADM 的唯一独立预测因素（均 p<0.0001）。快走与 MMRC 呈显著负相关（R=-0.70；p<0.001），且排除 MMRC 后，快走是 MRproANP 的唯一独立预测因素，但对 MRproADM 无预测作用（分别为 p=0.023 和 p=0.057）。
日常步行活动独立预测稳定期 COPD 患者循环中 MRproANP 和 MRproADM 的水平，这两种标志物与 COPD 恶化后的长期生存相关的心脏不良预后相关。在稳定期使用活动监测器可能会简化日常生活中的风险分层。
