慢性阻塞性肺疾病急性加重期血清cTnT增高患者的临床特征

Clinical characteristic of patients with cardiac troponin T rising in the acute stage of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)急性加重期心肌肌钙蛋白T(cTnT)增高患者的临床特征。方法对82例COPD急性加重期患者测定血清cTnT、动脉血气,做12导联心电图检查,并收集患者性别、年龄、生命体征、动脉粥样硬化危险因素(主动吸烟史、糖尿病史、高血压病史、高脂血症)等临床资料。结果82例COPD急性发作期住院患者共有15例(18.3%)cTnT增高;cTnT增高组与正常组比较,PaO2、PaCO2、pH、室性早搏发生率、右心衰竭发生率、ST段缺血性压低发生率、住院期间病死率差异有统计学意义(P<0.05或<0.01);cTnT与PaO2呈负相关(r=-0.447,P<0.01)。结论cTnT增高多见于发生失代偿酸中毒、右心、呼吸衰竭、室性早搏的患者,其病死率高于cTnT正常者。

[ Objective] To investigate the clinical characteristic of patients with with cardiac troponin T rising in the acute stage of chronic obstructive pulmonary disease. [ Methods] Measuring serum cTnT and arterial blood gas of eightytwo patients with confirmed acute exacerbation of chronic obstructive pulmonary disease, collecting general data, vital sign, risk factors for atherosclerotic artery disease（ active smoking, hypertension, diabetesmellitus, hyperlipidemia）. [ Results ] Cardiac troponin T was elevated in 15 of 82 （ 18.3% ） admissions with acute exacerbation of chronic obstructive pulmonary disease. Comparing patients with or without cTnT elevation, significant differences statistically were found for PaCO2 , the incidence of premature ventricular beats, the incidence of ST segment depression, the incidence of fight heart failure and mortality in-hospital, which were higher in patients with cTnT elevation, and for the PaO2, pH, which was lower. Correlative analysis between PaO2 and cTnT showed a negative correlation（ r = -0. 447, P 〈 0.01 ）. [ Conclusions ] cTnT elevation often presents in patients with acidosis, respiratory failure, fight ventricular dysfunction, premature ventricular beats and a higher mortality than normal cTnT.