Buchan Alice, Bennett Ruth, Coad Anna, Barnes Simon, Russell Richard, Manuel Ari R
Medical School, University of Oxford , Oxford , UK.
Medical School, St Hugh's College, University of Oxford , Oxford , UK.
Open Heart. 2015 Mar 26;2(1):e000052. doi: 10.1136/openhrt-2014-000052. eCollection 2015.
The presence of cardiovascular comorbidities is frequently associated with poor outcomes in chronic obstructive pulmonary disease (COPD). No clear role has been defined for cardiac biomarkers in acute exacerbations of COPD (AECOPD). The aim of this systematic review was to examine the prognostic value of brain natriuretic peptide (BNP) and troponins in patients with AECOPD. Two independent authors searched the PubMed and Cochrane Library to collect clinical trials, observational studies and meta-analyses studying the prognostic value of cardiac biomarkers in AECOPD. The reference lists of all the included studies were also reviewed. A total of 14 studies were included in the review, of which 10 measured troponins, 7 measured BNP or NT-proBNP, and 3 measured both. Of the studies that used mortality in AECOPD as an end point, some but not all found that elevated BNP and/or troponins were associated with increased mortality. Of the studies that used left ventricular (LV) dysfunction in AECOPD as an end point, all found a significant association between elevated BNP and troponins in the diagnosis of LV dysfunction. In summary, it appears that there may be a link between an elevated level of BNP or NT-proBNP and increased cardiovascular mortality in AECOPD, although the data currently available are not conclusive. The inconsistencies in biomarkers measured, time points of measurements and the variability in outcome measured preclude more robust analysis.
心血管合并症的存在常与慢性阻塞性肺疾病（COPD）的不良预后相关。目前尚无明确证据表明心脏生物标志物在慢性阻塞性肺疾病急性加重期（AECOPD）中发挥何种作用。本系统评价旨在探讨脑钠肽（BNP）和肌钙蛋白在AECOPD患者中的预后价值。两名独立作者检索了PubMed和Cochrane图书馆，以收集研究心脏生物标志物在AECOPD中预后价值的临床试验、观察性研究和荟萃分析。我们还对所有纳入研究的参考文献列表进行了审查。本评价共纳入14项研究，其中10项检测了肌钙蛋白，7项检测了BNP或NT-proBNP，3项同时检测了这两种指标。在以AECOPD患者死亡率作为终点的研究中，部分（而非全部）研究发现，BNP和/或肌钙蛋白升高与死亡率增加相关。在以AECOPD患者左心室（LV）功能障碍作为终点的研究中，所有研究均发现，BNP和肌钙蛋白升高与LV功能障碍的诊断之间存在显著关联。总之，尽管目前可得的数据尚无定论，但BNP或NT-proBNP水平升高与AECOPD患者心血管死亡率增加之间似乎可能存在联系。生物标志物检测、测量时间点及测量结果的变异性方面存在的不一致性，妨碍了更有力的分析。
