Hs-cTnT和H-FABP在COPD急性加重期患者心脏功能早期损害中的临床意义

Clinical value of high-sensitivity cardiac troponin T and Heart-type fatty acid-binding protein for early heart dysfunction assessment in patients with acute exacerbation of COPD

目的通过检测慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗前后血清高敏肌钙蛋白T(hs-cTnT)、心型脂肪酸结合蛋白(H-FABP)表达水平的变化,探讨它们在AECOPD患者心脏功能早期损害中的临床意义。方法对2015年12月—2016年6月安徽医科大学第一附属医院110例AECOPD住院患者进行研究,符合入组条件患者80例,其中轻、中度组35例,重度、极重度45例,同期40例门诊体检者为对照组。分别采用电化学发光法测定血清hs-cTnT、酶联免疫吸附法测定H-FABP,所有受试者完成肺功能检查、动脉血气、血清AST、LDH、CK、CKMB、c Tn I、肌红蛋白测定。结果与对照组相比,AECOPD组治疗前hs-cTnT及H-FABP的表达量均显著增高(P<0.01),其中重、极重度组治疗后的hs-cTnT和H-FABP表达量较治疗前显著降低,差异有统计学意义(P<0.01);c Tn I、AST、LDH、CK、CKMB、肌红蛋白表达量于治疗前后比较差异均无统计学意义(P>0.05)。结论与传统的心肌指标相比较,血清hs-cTnT和H-FABP对于早期判断AECOPD患者心肌损伤可能具有重要的临床价值,对早期进行临床干预具有指导意义。

Objective To explore clinical value of high-sensitivity cardiac troponin T（ hs-cTnT） and Heart-type fatty acid binding protein（ H-FABP） in assessing the early heart dysfunction in patients with acute exacerbations of chronic obstructive pulmonary disease（ COPD） by comparing the levels of hs-cTnT and H-FABP before and after treatment. Methods Total 110 patients with clinician-diagnosed AECOPD in our hospital were prospectively studied from December,2015 to June,2016. Among them,80 eligible patients,including 35 patients with mild-to-moderate acute exacerbations of chronic obstructive pulmonary disease（ AECOPD） and 45 ones with severe-to-very severe AECOPD were enrolled,and 40 control subjects were recruited. The serum hs-cTnT and H-FABP levels were tested by electrochemiluminescence method and enzyme-linked immunosorbent assay,respectively. The pulmonary function,arterial blood gas,AST,LDH,CK,CKMB,c Tn I and myoglobin were evaluated. Results There was a significantly higher levels of hs-cTnT and H-FABP in AECOPD patients compared with the control group（ P〈0. 01）. The levels of hs-cTnT and H-FABP were significantly decreased in severe-to-very severe AECOPD group after the treatment（ P〈0. 01）. There was no significant difference in AST,LDH,CK,CKMB,c Tn I and myoglobin before and after treatment（ P〈0. 05）. Conclusion Compared with the traditional myocardial biomarkers,hs-cTnT and H-FABP are more sensitive to myocardial damage and could guide early clinical intervention in patients with acute exacerbation of COPD.