University of Bristol, Bristol, UK.
Academic Respiratory Unit, North Bristol NHS Trust 2nd Floor Office, Learning and Research Building Southmead Hospital Southmead Way, Bristol, BS10 5NB, UK.
BMC Pulm Med. 2023 Aug 21;23(1):307. doi: 10.1186/s12890-023-02555-9.
Development of pleural effusion (PE) following CABG is common. Post-CABG PE are divided into early- (within 30 days of surgery) and delayed-onset (30 days-1 year) which are likely due to distinct pathological processes. Some experts suggest asbestos exposure may confer an independent risk for late-onset post-CABG PE, however no large studies have explored this potential association.
To explore possible association between asbestos exposure and post-CABG PE using routine data.
All patients who underwent CABG 01/04/2013-31/03/2018 were identified from the Hospital Episode Statistics (HES) Database. This England-wide population was evaluated for evidence of asbestos exposure, pleural plaques or asbestosis and a diagnosis of PE or PE-related procedure from 30 days to 1 year post-CABG. Patients with evidence of PE three months prior to CABG were excluded, as were patients with a new mesothelioma diagnosis.
68,150 patients were identified, of whom 1,003 (1%) were asbestos exposed and 2,377 (3%) developed late-onset PE. After adjusting for demographic data, Index of Multiple Deprivation and Charlson Co-morbidity Index, asbestos exposed patients had increased odds of PE diagnosis or related procedure such as thoracentesis or drainage (OR 1.35, 95% CI 1.03-1.76, p = 0.04). In those with evidence of PE requiring procedure alone, the adjusted OR was 1.66 (95% CI 1.14-2.40, p = 0.01). Additional subgroup analysis of the 518 patients coded for pleural plaques and asbestosis alone revealed an adjusted OR of post-CABG PE requiring a procedure of 2.16 (95% CI 1.38-3.37, p = 0.002).
This large-scale study demonstrates prior asbestos exposure is associated with modestly increased risk of post-CABG PE development. The risk association appears higher in patients with assigned clinical codes indicative of radiological evidence of asbestos exposure (pleural plaques or asbestosis). This association may fit with a possible inflammatory co-pathogenesis, with asbestos exposure 'priming' the pleura resulting in greater propensity for PE evolution following the physiological insult of CABG surgery. Further work, including prospective studies and clinicopathological correlation are suggested to explore this further.
CABG 术后胸腔积液（PE）的发生较为常见。CABG 术后的 PE 分为早发（手术 30 天内）和迟发（30 天-1 年），这可能是由于不同的病理过程所致。一些专家认为，石棉暴露可能会给迟发性 CABG 术后的 PE 带来独立的风险，但尚未有大型研究探讨这种潜在的关联。
利用常规数据探讨石棉暴露与 CABG 术后 PE 之间的可能关联。
从医院病例统计数据库（HES）中确定了 2013 年 4 月 1 日至 2018 年 3 月 31 日期间接受 CABG 的所有患者。对英格兰范围内的人群进行了石棉暴露、胸膜斑或石棉沉着病以及 CABG 术后 30 天至 1 年期间 PE 或 PE 相关手术的证据评估。排除了 CABG 前三个月有 PE 证据的患者，以及有新的间皮瘤诊断的患者。
共确定了 68150 名患者，其中 1003 名（1%）暴露于石棉，2377 名（3%）发生迟发性 PE。在调整了人口统计学数据、多因素贫困指数和 Charlson 合并症指数后，暴露于石棉的患者发生 PE 诊断或相关手术（如胸腔穿刺或引流）的几率更高（比值比 1.35，95%置信区间 1.03-1.76，p=0.04）。在那些仅需要手术治疗的 PE 患者中，调整后的比值比为 1.66（95%置信区间 1.14-2.40，p=0.01）。对单独编码为胸膜斑和石棉沉着病的 518 名患者进行的亚组分析显示，需要手术治疗的 CABG 后 PE 的调整后比值比为 2.16（95%置信区间 1.38-3.37，p=0.002）。
这项大规模研究表明，既往石棉暴露与 CABG 后 PE 发生的风险适度增加相关。在有临床编码提示存在石棉暴露（胸膜斑或石棉沉着病）的放射学证据的患者中，风险关联更高。这种关联可能符合一种可能的炎症性共发病理机制，石棉暴露“启动”胸膜，导致 CABG 手术后生理损伤后 PE 发展的倾向性更高。建议进一步开展包括前瞻性研究和临床病理相关性研究在内的进一步工作，以进一步探讨这一问题。
