犬冠状动脉旁路移植术后C反应蛋白与心房肌电生理改变有关

C-reactive protein was associated with the electrophysiological changes after coronary artery bypass grafting in canine model

目的探讨犬冠状动脉旁路移植(CABG)术后C反应蛋白(CRP)增高的程度及其与心房肌电生理改变的关系。方法24只成年杂种犬随机分为4组,实验组1～3分别为：无菌性心包炎组、模拟CABG手术组、模拟CABG手术并给予甲基强的松龙2 mg·kg^(-1)·d^(-1)心包内注射(激素组),对照组为假手术组,开胸但不打开心包。经右颈外静脉放置10极冠状静脉窦标测导管和经右股静脉放置10极界嵴标测导管,于手术当天及术后4d内每天测量左、右心房有效不应期(ERP_(LA)和ERP_(RA)),左、右心房内传导速度(LACV和RACV)和左、右心房间传导速度(inter-atrium conduction velocity,IACV)；并于每天电生理参数测定前经右肘静脉抽血5ml,采用免疫浊度终点测定法测定犬的血清CRP浓度。结果手术当天,4组犬之间的各项电生理参数和CRP浓度的差异均无统计学意义；术后第1天起,与激素组和对照组相比,心包炎组和CABG组具有较短的ERP_(LA)(81．67、91．67 vs 106．67、101．67)和ERP_(RA) (96．67、93．33 vs 113．33、118．33)、较慢的LACV(87．83、87．65 vs 97．20、97．60)、RACV(88．40、89．60 vs 99．05、99．48)和IACV(87．58、88．60 vs 98．00、98．35)、较高的CRP浓度(225．33、208．17 vs 107．02、112．53),P均＜0．05,其变化于术后第2、第3天达到极点；术后各天心房肌电生理参数的改变与CRP浓度密切相关(r=0．65～-0．88,P均＜0．0001)。结论CABG手术后伴发了严重的炎症反应和电生理参数改变,且电生理参数的改变与CRP浓度密切相关,激素治疗可以有效地降低CRP浓度,并且有效地抑制了心房肌电生理参数的改变。

Objective This study was designed to explore the extension and timing pattern of C-reactive protein（CRP） elevation after coronary artery bypass grafting（CABG） and its relationship with the alteration of atrial electrophysiological parameters （AEPPs） in canine model. Methods Twenty-four mongrel dogs were randomly divided into 4 groups （ n = 6 for each group）, the experimental groups 1 -3include：sterile pericarditis group, CABG group, steroid group（ after CABG surgery was completed, the dogs were given methylprednisolone 2 mg/kg intra-pericardially every day on the operation day and post-operatiove day 1 to day 4）, and a control group,with thoracotomy only. Two decapolar mapping catheters were positioned in coronary sinus（CS） and cristal terminalis（CT） through right jugular vein and right femoral vein respectively. The effective refractory period, the intra-atrium conduction velocity （ IACV ） of the left and right atrium （ ERPLA, ERPRA, LACV, and RACV, ） and the IACV were measured on the operation day and post-operatively from day 1 to day 4 respectively. The CRP levels of blood serum were measured during each time of AEPPs test. Results On the operation day, there was no significant difference in all AEPPs and CRP levels among 4 groups. On the first day after surgery,compared to steroid group and control group, pericarditis group and CABG group had shorter ERPLA （ 81.67.91.67 vs 106. 67.101.67） and ERPRA （96.67,93. 33 vs 113. 33.118.33 ） , slower LACV （ 87.83, 87.65 vs 97.20,97.60）, RACV （88.40,89.60 vs 99.05,99.48 ）, and IACV （87. 58,88. 60 vs 98.00,98. 35 ） and higher CRP levels（225.33,208.17 vs 107.02,112.53 ） with the P 〈 0. 05 for all measurements. The changes in AEEPs and CRP levels were peeked on the second and third day pest-operatively. The alteration of AEEPs on each post-operative day was correlated with CRP levels （ r = - 0. 65 - - 0. 88, P 〈 0. 0001 ）. Conclusion there were severe inflammatory reaction and atrial eleetrophysiologieal changes after CABG. The atrial eleetrophysiological changes were negatively eorelated to the degree of CRP elevation. Steroid intervention could effectively reduce the CRP levels and prevent the atrial eleetrophysiologieal changes.