Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran..
Kardiol Pol. 2018;76(2):440-451. doi: 10.5603/KP.a2017.0242. Epub 2018 Jan 22.
Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses.
This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures.
We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A compre-hensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity.
A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF.
Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF.
术后心房颤动（POAF）是心脏手术后一种发病率高且具有严重临床意义的主要心律失常。心脏手术与全身性炎症反应相关，包括细胞因子的增加以及内皮细胞和白细胞反应的激活。
本系统评价和荟萃分析旨在确定评估炎症标志物（如 C 反应蛋白（CRP）和白细胞介素（IL））与孤立性冠状动脉旁路移植术（CABG）、孤立性瓣膜手术或这些手术联合后 POAF 相关性的证据强度。
我们对评估 POAF 患者基线（手术前一周）和术后（手术结束后一周内）炎症标志物测量值的研究进行了荟萃分析。从成立之初到 2017 年 5 月，我们在电子医学数据库（Medline/PubMed、Web of Science、Embase、Science Direct 和 Google Scholar）中进行了全面检索，以确定相关研究。进行了全面的亚组分析，以探索潜在的异质性来源。
对所有主要数据库的文献检索共检索到 1014 项研究。筛选后，分析了 42 项研究，共纳入 8398 例患者。汇总分析显示 CRP 基线水平（标准化均数差 [SMD] 0.457mg/L，p<0.001）、IL-6 基线水平（SMD 0.398pg/mL，p<0.001）、CRP 术后水平（SMD 0.576mg/L，p<0.001）、IL-6 术后水平（SMD 1.66pg/mL，p<0.001）、IL-8 术后水平（SMD 0.839pg/mL，p<0.001）和 IL-10 术后水平（SMD 0.590pg/mL，p<0.001）是与 POAF 显著相关的炎症参数。
围手术期炎症被认为与 POAF 的发病机制有关。因此，围手术期 CRP、IL-6、IL-8 和 IL-10 的评估有助于临床医生预测和监测 POAF。
