Howard-Alpe G M, Sear J W, Foex P
Nuffield Department of Anaesthetics, John Radcliffe Hospital Headley Way, Headington, Oxford OX3 9DU, UK.
Br J Anaesth. 2006 Dec;97(6):758-69. doi: 10.1093/bja/ael303. Epub 2006 Oct 30.
Atherosclerosis is a common condition in both the developed and developing world and is now recognised to be an inflammatory condition leading to the development of ischaemic heart disease, cerebrovascular disease and peripheral vascular disease. Ischaemic heart disease is a major risk factor in the pathogenesis of perioperative adverse cardiovascular events which lead to significant morbidity and mortality within the high risk surgical patient population. Current methods of evaluating the likelihood of postoperative cardiovascular complications depend largely on risk scoring systems, and the preoperative assessment of the functional status of the cardiovascular system. However, the possible role of inflammation in the generation of atherosclerosis has led to the identification of several biochemical markers such as acute phase proteins, cellular adhesion molecules and cytokines. An alternative approach therefore is the measurement of preoperative levels of these biomarkers with the aim of assessing pre-existing disease activity. This review summarises the pathophysiology of atherosclerosis and perioperative myocardial infarction, and discusses the possible future role of biomarkers in the risk stratification of patients undergoing non-cardiac surgery.
动脉粥样硬化在发达国家和发展中国家都是一种常见病症，目前被认为是一种炎症性病症，可导致缺血性心脏病、脑血管疾病和外周血管疾病的发生。缺血性心脏病是围手术期不良心血管事件发病机制中的主要危险因素，这些事件会导致高危手术患者群体出现显著的发病率和死亡率。当前评估术后心血管并发症可能性的方法很大程度上依赖于风险评分系统以及心血管系统功能状态的术前评估。然而，炎症在动脉粥样硬化形成过程中可能发挥的作用促使人们识别出了几种生化标志物，如急性期蛋白、细胞黏附分子和细胞因子。因此，另一种方法是测量这些生物标志物的术前水平，目的是评估已存在的疾病活动情况。本综述总结了动脉粥样硬化和围手术期心肌梗死的病理生理学，并讨论了生物标志物在非心脏手术患者风险分层中未来可能发挥的作用。
