Noorain Saleha
Department of General Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India.
Lung India. 2016 Jan-Feb;33(1):53-7. doi: 10.4103/0970-2113.173052.
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity. It is the fourth leading cause of death worldwide. Acute exacerbations of COPD are common and are associated with worsening lung function and mortality.
To evaluate the prevalence of elevation of cTnI in patients admitted with acute exacerbation of COPD and to study its association with the need for ventilator support, duration of hospital stay, and in-hospital mortality.
In a prospective design, 50 patients admitted to our hospital with acute exacerbation of COPD were included. cTnI was assayed in a blood sample obtained at admission and 24 h later. Levels above 0.017 µg/L were taken as positive. The following data were also recorded-demographic data, pattern of tobacco use, clinical symptoms and signs, comorbidities, Glasgow Coma Scale, arterial blood gas, electrocardiogram/two-dimensional echocardiography, chest X-ray, and peak expiratory flow rate.
Among the 50 patients, 4 were females, and 46 were males. cTnI was positive in 32% of patients with a mean value of 0.272. Patients with cTnI positive were taken as Group I and those with negative were included in Group II. Prevalence of comorbidities was higher in cTnI positive group, so was the duration of COPD. cTnI elevation correlated significantly with the need for ICU admission and ventilator support. No significant difference was found in the duration of ventilator support, hospital stay, and in-hospital mortality.
cTnI is elevated in a significant subset of patients with acute exacerbation of COPD. Duration of their illness was longer, higher incidence of ischemic heart disease was also found in these patients. Patients with cTnI elevation are more likely to require ICU care and ventilator support. However, it did not predict in-hospital mortality. Thus, it can be used as a marker to identify high-risk patients during acute exacerbation of COPD.
慢性阻塞性肺疾病（COPD）是导致死亡和发病的主要原因。它是全球第四大死因。COPD急性加重很常见，且与肺功能恶化和死亡率相关。
评估因COPD急性加重入院患者中肌钙蛋白I（cTnI）升高的患病率，并研究其与呼吸机支持需求、住院时间和院内死亡率的关系。
采用前瞻性设计，纳入我院50例因COPD急性加重入院的患者。在入院时及24小时后采集的血样中检测cTnI。高于0.017μg/L的水平被视为阳性。还记录了以下数据——人口统计学数据、吸烟模式、临床症状和体征、合并症、格拉斯哥昏迷量表、动脉血气、心电图/二维超声心动图、胸部X线和呼气峰值流速。
50例患者中，4例为女性，46例为男性。32%的患者cTnI呈阳性，平均值为0.272。cTnI阳性患者被归为I组，阴性患者被纳入II组。cTnI阳性组的合并症患病率更高，COPD病程也是如此。cTnI升高与入住重症监护病房（ICU）和呼吸机支持需求显著相关。在呼吸机支持时间、住院时间和院内死亡率方面未发现显著差异。
在相当一部分COPD急性加重患者中cTnI升高。这些患者的病程更长，缺血性心脏病的发病率也更高。cTnI升高的患者更有可能需要ICU护理和呼吸机支持。然而，它不能预测院内死亡率。因此，它可作为COPD急性加重期间识别高危患者的标志物。
