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本文摘自2013年11月1日刊American Journal of Respiratory and Critical Care Medicine，《美国呼吸和危重医学杂志》 Cardiovascular Risk, Myocardial Injury, and Exacerbations of Chronic Obstructive Pulmonary Disease 慢性阻塞性肺疾病急性发作、心血管风险和心肌损伤 Rationale: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and myocardial injury is common during severe exacerbations. Little is known about the prevalence, magnitude, and underlying mechanisms of cardiovascular risk in community-treated exacerbations. 原理：慢性阻塞性肺疾病（COPD）患者的心血管疾病风险增加，其急性发作时常见心肌损伤。但社区COPD患者的心血管疾病患病率、影响范围和相关机制仍未明确。 Objectives: To investigate how COPD exacerbations and exacerbation frequency impact cardiovascular risk and myocardial injury, and whether this is related to airway infection and inflammation. 目的：评估COPD急性发作和发作频率对心血管疾病风险和心肌损伤的影响，并明确是否与呼吸道感染和炎症有关。 Methods: We prospectively measured arterial stiffness (aortic pulse wave velocity [aPWV]) and cardiac biomarkers in 98 patients with stable COPD. Fifty-five patients had paired stable and exacerbation assessments, repeated at Days 3, 7, 14, and 35 during recovery. Airway infection was identified using polymerase chain reaction. 方法：我们首先在98名稳定型COPD患者身上进行检查，包括动脉僵硬度（主动脉脉搏波传导速度[aPWV]）和心肌标记物。其中55名患者从病情稳定发展为急性发作，在康复期的第3、7、14和35天重复相关检查。利用聚合酶链反应评估气道感染。 Measurements and Main Results: COPD exacerbation frequency was related to stable-state arterial stiffness (rho = 0.209; P = 0.040). Frequent exacerbators had greater aPWV than infrequent exacerbators (mean ± SD aPWV, 11.4 ± 2.1 vs. 10.3 ± 2.0 ms?1; P = 0.025). Arterial stiffness rose by an average of 1.2 ms?1 (11.1%) from stable state to exacerbation (n = 55) and fell slowly during recovery. In those with airway infection at exacerbation (n = 24) this rise was greater (1.4 ± 1.6 vs. 0.7 ± 1.3 ms?1; P = 0.048); prolonged; and related to sputum IL-6 (rho = 0.753; P < 0.001). Increases in cardiac biomarkers at exacerbation were higher in those with ischemic heart disease (n = 12) than those without (n = 43) (mean ± SD increase in troponin T, 0.011 ± 0.009 vs. 0.003 ± 0.006 μg/L, P = 0.003; N-terminal pro–brain natriuretic peptide, 38.1 ± 37.7 vs. 5.9 ± 12.3 pg/ml, P < 0.001). 结果：COPD的发作频率与动脉僵硬度的稳定状态有关。经常出现急性发作的患者，其aPWV值更高。随着病情稳定发展为急性发作，动脉僵硬度也出现相应增加，并在康复时期逐渐下降。合并呼吸道感染的患者，动脉僵硬度的升幅更大，持续时间更长，并与痰液的IL-6有关。COPD合并缺血性心脏病患者在急性发作时，心肌标记物的上升幅度更大。 Conclusions: Frequent COPD exacerbators have greater arterial stiffness than infrequent exacerbators. Arterial stiffness rises acutely during COPD exacerbations, particularly with airway infection. Increases in arterial stiffness are related to inflammation, and are slow to recover. Myocardial injury is common and clinically significant during COPD exacerbations, particularly in those with underlying ischemic heart disease. 结论：COPD经常性疾病发作与动脉僵硬度增加有关。COPD急性发作期间，动脉僵硬度可出现急剧上升，合并呼吸道感染时更为明显，动脉僵硬度增加与炎症有关，且恢复缓慢。COPD急性发作期间的心肌损伤很常见且非常明显，合并缺血性心脏病的患者更容易受到影响。 |
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