术前全身炎症与围术期心肌损伤：接受非心脏手术患者的前瞻性观察性多中心队列研究。
Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery.
机构信息
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
出版信息
Br J Anaesth. 2019 Feb;122(2):180-187. doi: 10.1016/j.bja.2018.09.002. Epub 2018 Oct 2.
BACKGROUND
Systemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) >4, predisposes patients to perioperative myocardial injury.
METHODS
We prospectively recruited 1652 patients aged ≥45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT≥14 ng L within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR>4, activated reactive oxygen species (ROS) generation in circulating monocytes, or both. Multivariable logistic regression analysis explored associations between age, sex, NLR, Revised Cardiac Risk Index, individual leukocyte subsets, and myocardial injury. Flow cytometric quantification of ROS was done in 21 patients. Data are presented as n (%) or odds ratio (OR) with 95% confidence intervals.
RESULTS
Preoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92-3.41); P<0.0001]. Myocardial injury was independently associated with lower absolute preoperative lymphocyte count [OR 1.80 (1.50-2.17); P<0.0001] and higher absolute preoperative monocyte count [OR 1.93 (1.12-3.30); P=0.017]. Monocyte ROS generation correlated with NLR (r=0.47; P=0.03).
CONCLUSIONS
Preoperative NLR>4 is associated with perioperative myocardial injury, independent of conventional risk factors. Systemic inflammation may contribute to the development of perioperative myocardial injury.
CLINICAL TRIAL REGISTRATION
NCT01842568.
背景
全身性炎症在心血管疾病的发病机制中起着关键作用。由于炎症可直接导致心肌细胞损伤，因此我们假设术前中性粒细胞与淋巴细胞比值（NLR）升高（>4）反映了已建立的全身性炎症，使患者易发生围手术期心肌损伤。
方法
我们前瞻性招募了在英国两个中心接受非心脏手术的 1652 名年龄≥45 岁的患者。在术后第 1 至 3 天测量血清高敏肌钙蛋白 T（hsTnT）浓度。临床医生和研究人员对肌钙蛋白结果均不知情。主要结局是围手术期心肌损伤，定义为术后 3 天内 hsTnT≥14ng/L。我们评估了心肌损伤是否与术前 NLR>4、循环单核细胞中活性氧（ROS）的产生有关，或与两者都有关。多变量逻辑回归分析探讨了年龄、性别、NLR、改良心脏风险指数、白细胞亚群与心肌损伤之间的关系。在 21 名患者中进行了 ROS 的流式细胞术定量。数据以 n（%）或比值比（OR）和 95%置信区间表示。
结果
术前 NLR>4 见于 1652 名患者中的 239 名（14.5%）。1652 名患者中有 405 名（24.5%）发生心肌损伤，且术前 NLR>4 的患者更为常见[OR：2.56（1.92-3.41）；P<0.0001]。心肌损伤与术前绝对淋巴细胞计数较低独立相关[OR 1.80（1.50-2.17）；P<0.0001]，与术前绝对单核细胞计数较高独立相关[OR 1.93（1.12-3.30）；P=0.017]。单核细胞 ROS 生成与 NLR 相关（r=0.47；P=0.03）。
结论
术前 NLR>4 与围手术期心肌损伤相关，独立于传统危险因素。全身性炎症可能导致围手术期心肌损伤的发生。
临床试验注册
NCT01842568。
Zotero 插件