Guzzetti Stefano, Costantino Giorgio, Sada Simona, Fundarò Camilla
Ospedale Luigi Sacco, Università, Milano.
Recenti Prog Med. 2003 Jun;94(6):260-3.
We undertook a study to provide a quantitative basis to the clinical observation of an unexpected high frequency of atrial fibrillation in patients with colorectal cancer. In our study we considered a total of 1463 patients admitted during a period of 12 years (1987-1998) to the Department of Surgery of our Hospital for surgical treatment of colorectal cancer (case group: mean age 66 years) or non-neoplastic diseases including inguinal hernia, cholelithiasis, varicose veins and hemorrhoids (control group: mean age 65.6 years). We found a three times higher likelihood of having atrial fibrillation in patients with first diagnosis of colorectal cancer compared to controls. Logistic analysis was used to exclude an effect of age. Our study suggests that atrial fibrillation could be considered a non metastatic effect of colorectal cancer. Several pathophysiological mechanisms could explain this observation. A recent study, which reports a significant elevation of C-reactive protein in patients with atrial fibrillation, suggests that this arrhythmia could be promoted by a systemic inflammatory state. In conclusion, atrial fibrillation could be considered a pathological condition not only dependent to organic heart diseases; further studies are needed to evaluate the real impact of systemic inflammatory state or other non-cardiovascular diseases on the excess of mortality in the patients with atrial fibrillation.
我们开展了一项研究，旨在为临床观察结直肠癌患者中意外出现的高房颤发生率提供定量依据。在我们的研究中，我们共纳入了1463例患者，这些患者在12年期间（1987 - 1998年）因结直肠癌手术治疗（病例组：平均年龄66岁）或非肿瘤性疾病（包括腹股沟疝、胆结石、静脉曲张和痔疮）入住我院外科（对照组：平均年龄65.6岁）。我们发现，初诊为结直肠癌的患者发生房颤的可能性是对照组的三倍。采用逻辑分析排除年龄因素的影响。我们的研究表明，房颤可被视为结直肠癌的一种非转移效应。几种病理生理机制可以解释这一观察结果。最近一项研究报告称房颤患者的C反应蛋白显著升高，这表明这种心律失常可能由全身炎症状态引发。总之，房颤不仅可被视为一种依赖于器质性心脏病的病理状态；还需要进一步研究来评估全身炎症状态或其他非心血管疾病对房颤患者额外死亡率的实际影响。
