Ramlawi Basel, Otu Hasan, Mieno Shigetoshi, Boodhwani Munir, Sodha Neel R, Clements Richard T, Bianchi Cesario, Sellke Frank W
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Ann Thorac Surg. 2007 Oct;84(4):1166-72; discussion 1172-3. doi: 10.1016/j.athoracsur.2007.04.126.
New-onset postoperative atrial fibrillation (PAF) continues to be among the most common complications after cardiac surgery, leading to significant morbidity and cost. We studied the role of oxidative stress on patients after cardiopulmonary bypass.
Patients undergoing coronary artery bypass grafting or valve procedures who exhibited new-onset PAF (n = 11) and those who remained in sinus rhythm (n = 13) were prospectively matched based on preoperative, intraoperative, and postoperative characteristics. Postoperative atrial fibrillation was assessed by electrocardiogram and must have required initiation of antiarrhythmic therapy or anticoagulation. Right atrial and skeletal muscle samples were harvested before and after cardiopulmonary bypass for oxidative protein immunostaining (Oxyblot assay). Serum samples were collected preoperatively and postoperatively at 6 hours and day 4 for microarray assessment of gene expression and to quantify total peroxide levels.
Patients with PAF had significantly more elevation in total peroxide levels in serum compared with patients in sinus rhythm at 6 hours (5.83 +/- 1.9 versus 2.02 +/- 0.2 fold, respectively; p = 0.039) but not at day 4 (3.81 +/- 1.2 versus 2.17 +/- 0.5 fold, respectively; p = 0.188). Patients with PAF also had significantly more myocardial oxidation compared with patients in sinus rhythm at 6 hours (4.19 +/- 1.4 versus 0.94 +/- 0.3 fold, respectively; p = 0.021). Increased serum peroxide levels in patients who exhibited PAF correlated with elevated myocardial protein oxidation but not peripheral muscle oxidation. Gene expression analysis revealed a differential genomic response in patients with new-onset PAF (more oxidation) compared with patients in sinus rhythm (more reduction).
Patients who exhibit PAF after cardiac surgery have significantly increased acute oxidative stress, which translates into increased myocardial oxidation. Also, patients with PAF have a differential oxidative genomic response after cardiopulmonary bypass that may predispose them to oxidative stress.
术后新发房颤（PAF）仍是心脏手术后最常见的并发症之一，会导致显著的发病率和费用增加。我们研究了氧化应激在体外循环术后患者中的作用。
对接受冠状动脉旁路移植术或瓣膜手术且出现新发PAF的患者（n = 11）和维持窦性心律的患者（n = 13），根据术前、术中和术后特征进行前瞻性匹配。通过心电图评估术后房颤情况，且必须已开始抗心律失常治疗或抗凝治疗。在体外循环前后采集右心房和骨骼肌样本进行氧化蛋白免疫染色（Oxyblot检测）。术前以及术后6小时和第4天采集血清样本，用于基因表达的微阵列评估和总过氧化物水平的定量分析。
与窦性心律患者相比，PAF患者在术后6小时血清总过氧化物水平显著升高（分别为5.83±1.9倍和2.02±0.2倍；p = 0.039），但在第4天无显著差异（分别为3.81±1.2倍和2.17±0.5倍；p = 0.188）。与窦性心律患者相比，PAF患者在术后6小时心肌氧化也显著增加（分别为4.19±1.4倍和0.94±0.3倍；p = 0.021）。出现PAF的患者血清过氧化物水平升高与心肌蛋白氧化增加相关，但与外周肌肉氧化无关。基因表达分析显示，新发PAF患者（氧化程度更高）与窦性心律患者（还原程度更高）相比，存在不同的基因组反应。
心脏手术后出现PAF的患者急性氧化应激显著增加，这导致心肌氧化增加。此外，PAF患者在体外循环后存在不同的氧化基因组反应，这可能使他们易患氧化应激。
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