肌钙蛋白Ⅰ对慢性阻塞性肺疾病患者院内死亡的临床预测价值

Clinical predictive value of cTnI in mortality of hospitalized COPD patients

目的调查研究升高的肌钙蛋白Ⅰ(cTnI)水平对慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者存活的预测价值。方法采用整群抽样方法确定此次调查对象并进行统计学分析。结果从3个医院选出符合入选标准者共4960例,其中979例检测了血清cTnI,男710例,女269例,年龄(73.1±10.5)岁。除糖尿病和性别因素外,cTnI水平与COPD死亡组的年龄、缺血性心脏病、充血性心力衰竭、心房颤动、二氧化碳分压(PaCO2)、血氧分压(PaO2)差异均有统计学意义(P<0.01)。Logsitic多因素分析显示,年龄、缺血性心脏病和cTnI水平与死亡明显相关(相对危险度分别为2.7832、2.5350和1.3111,95%CI 0.99753～5.6199,均P<0.05),而PaCO2和PaO2与死亡的相关性明显较弱(P>0.05)。结论继缺血性心脏病和年龄之后,cTnI水平成为COPD第3个最有价值的病死率的预测因素,优于动脉血气值。

Objective To study the predictive value of the elevated cyclic troponin-I（cTnI）level to the survival of chronic obstructive pulmonary disease（COPD）patients.Methods There are 4960 cases picked out of three hospitals.Of all 4960 cases,serum cTnI levels in 979 cases were measured,710 male,269 female,mean=（73.1±10.5）yrs.The group sampling method was used to assess the data and statistical analysis was carried out.Results It was indicated that there was a significant correlation between the cTnI level and age,smoking,anemic heart disease,congestive heart failure,auricular fibrillation,PaCO2 and PaO2（all P0.01）in the mortality of CDPD patients.Diabetes and sex,however,did not play a major role.Except PaCO2 and PaO2,cTnI level,age and anemic heart disease were obviously correlative with the death of CDPD patients（RR=1.3111,2.5350 and 2.7832,95%CI：0.99753-5.6199,all P0.01）,which was reflected by Logsitic multivariate analysis.Conclusions The cTnI may be the third most valuable predictive marker after age and anemic heart disease for the death of COPD patients,and it is a better marker than artery blood-gas data.