Fontes Manuel L, Mathew Joseph P, Rinder Henry M, Zelterman Daniel, Smith Brian R, Rinder Christine S
Department of Anesthesiology, Yale School of Medicine, PO Box 208051, 333 Cedar St., New Haven, CT 06520-8051, USA.
Anesth Analg. 2005 Jul;101(1):17-23, table of contents. doi: 10.1213/01.ANE.0000155260.93406.29.
Atrial fibrillation (AF) contributes significantly to morbidity and mortality in as many as one-third of patients after cardiac surgery that requires cardiopulmonary bypass (CPB). Recent data suggest that inflammatory infiltration of the myocardium may predispose to AF. We conducted an exploratory pilot study to determine if there was an association between the perioperative leukocyte inflammatory response to cardiac surgery/CPB and postoperative AF. We enrolled 72 patients undergoing cardiac surgery with CPB; all patients were in sinus rhythm before surgery. Leukocyte activation (CD11b upregulation) was perioperatively measured in monocytes and neutrophils (PMN). Preoperative C-reactive protein (CRP) and perioperative neutrophil myeloperoxidase (MPO) were also monitored for inflammation, and troponin I was assayed for perioperative cardiac muscle damage. All markers were evaluated for differences between the subset of patients who developed AF versus those who remained in normal sinus rhythm after surgery. All 72 patients completed the study. Postoperative AF developed in 26 (36%) patients. Perioperative monocyte CD11b upregulation was significantly increased in patients who developed AF (P = 0.01), but increases in PMN CD11b were not significantly associated with AF (P = 0.057). The increase in both monocyte and PMN counts after aortic cross-clamp release was significantly associated with postoperative AF (P = 0.007 and P = 0.005, respectively). By contrast, preoperative CRP and perioperative MPO did not differ between AF and normal rhythm patients. Similarly, the peak value of troponin I did not differ between groups. In this pilot study of cardiac surgery/CPB patients, perioperative upregulation of the monocyte adhesion receptor, CD11b, and higher circulating monocyte and PMN numbers were associated with postoperative AF, suggesting that the induction of cellular inflammation during cardiac surgery/CPB may contribute to this pathophysiology.
在需要体外循环（CPB）的心脏手术后，多达三分之一的患者会出现心房颤动（AF），这对发病率和死亡率有显著影响。最近的数据表明，心肌的炎症浸润可能易引发房颤。我们进行了一项探索性初步研究，以确定围手术期白细胞对心脏手术/CPB的炎症反应与术后房颤之间是否存在关联。我们纳入了72例接受CPB心脏手术的患者；所有患者术前均为窦性心律。围手术期测量单核细胞和中性粒细胞（PMN）中的白细胞活化（CD11b上调）情况。还监测术前C反应蛋白（CRP）和围手术期中性粒细胞髓过氧化物酶（MPO）以评估炎症，并检测肌钙蛋白I以评估围手术期心肌损伤。评估所有标志物在术后发生房颤的患者亚组与术后维持正常窦性心律的患者亚组之间的差异。所有72例患者均完成了研究。26例（36%）患者术后发生房颤。发生房颤的患者围手术期单核细胞CD11b上调显著增加（P = 0.01），但PMN CD11b的增加与房颤无显著关联（P = 0.057）。主动脉阻断解除后单核细胞和PMN计数的增加均与术后房颤显著相关（分别为P = 0.007和P = 0.005）。相比之下，房颤患者与正常心律患者的术前CRP和围手术期MPO无差异。同样，两组之间肌钙蛋白I的峰值也无差异。在这项针对心脏手术/CPB患者的初步研究中，围手术期单核细胞黏附受体CD11b的上调以及循环单核细胞和PMN数量的增加与术后房颤相关，提示心脏手术/CPB期间细胞炎症的诱导可能促成了这一病理生理过程。
