Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation
Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation
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DOI：
10.1213/01.ane.0000155260.93406.29
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发表时间：
2005-07-01
影响因子：
5.7
通讯作者：
Rinder, CS
中科院分区：
文献类型：
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作者：
Fontes, ML;Mathew, JP;Rinder, CS
在需要体外循环(CPB)的心脏手术后，多达三分之一的患者房颤(AF)是导致发病率和死亡率的重要因素。最近的数据表明，心肌炎性浸润可能是房颤的易感因素。我们进行了一项探索性的先导性研究，以确定心脏手术/体外循环围手术期的白细胞炎症反应与术后房颤之间是否存在关联。我们招募了72名在体外循环下接受心脏手术的患者，所有患者在手术前都处于窦性心律。围手术期检测单核细胞和中性粒细胞(PMN)中白细胞的活化(CD11b上调)。术前监测C-反应蛋白(CRP)和围手术期中性粒细胞髓过氧化物酶(MPO)，检测肌钙蛋白I检测围手术期心肌损伤。评估所有标记物在术后发生房颤的患者和保持正常窦性心律的患者之间的差异。所有72名患者都完成了这项研究。术后发生房颤26例(36%)。房颤患者围手术期单核细胞CD11b表达明显增加(P=0.057)，而中性粒细胞CD11b表达增加与房颤无明显相关性(P=0.05)。单核细胞和中性粒细胞数量的增加与术后房颤显著相关(分别为P=0.007和P=0.005)。相比之下，房颤患者和正常节律患者的术前C反应蛋白和围手术期MPO无差异。同样，肌钙蛋白I的峰值在不同组之间没有差异。在这项针对心脏手术/体外循环患者的先导性研究中，围术期单核细胞黏附受体CD11b的上调以及循环中单核细胞和中性粒细胞数量的增加与术后房颤有关，提示心脏手术/体外循环期间细胞炎症的诱导可能参与了这种病理生理机制。
Atrial fibrillation (AF) contributes significantly to morbidity and mortality in as many as one-third of patients after cardiac surgery that requires cardiopulmonary bypass (CPB). Recent data suggest that inflammatory infiltration of the myocardium may predispose to AF. We conducted an exploratory pilot study to determine if there was an association between the perioperative leukocyte inflammatory response to cardiac surgery/CPB and postoperative AF. We enrolled 72 patients undergoing cardiac surgery with CPB; all patients were in sinus rhythm before surgery. Leukocyte activation (CD11b upregulation) was perioperatively measured in monocytes and neutrophils (PMN). Preoperative C-reactive protein (CRP) and perioperative neutrophil myeloperoxidase (MPO) were also monitored for inflammation, and troponin I was assayed for perioperative cardiac muscle damage. All markers were evaluated for differences between the subset of patients who developed AF versus those who remained in normal sinus rhythm after surgery. All 72 patients completed the study. Postoperative AF developed in 26 (36%) patients. Perioperative monocyte CD11b upregulation was significantly increased in patients who developed AF (P = 0.01), but increases in PMN CD11b were not significantly associated with AF (P = 0.057). The increase in both monocyte and PMN counts after aortic cross-clamp release was significantly associated with postoperative AF (P = 0.007 and P = 0.005, respectively). By contrast, preoperative CRP and perioperative MPO did not differ between AF and normal rhythm patients. Similarly, the peak value of troponin I did not differ between groups. In this pilot study of cardiac surgery/CPB patients, perioperative upregulation of the monocyte adhesion receptor, CD11b, and higher circulating monocyte and PMN numbers were associated with postoperative AF, suggesting that the induction of cellular inflammation during cardiac surgery/CPB may contribute to this pathophysiology.