心肌纤维化与冠脉搭桥术后心房颤动发生的关系研究

Correlation of atrial fibrosis and atrial fibrillation after coronary artery bypass grafting

目的探讨心房心肌纤维化与冠脉搭桥术后心房颤动发生的关系。方法根据冠脉搭桥术后是否发生心房颤动,将47例冠状动脉粥样硬化性心脏病患者分为心房颤组（房颤组）和未发生心房颤动组（对照组）。在术中体外循环前留取右心耳标本。Masson染色后对标本中胶原纤维含量进行半定量测量,计算心房组织心肌胶原容积分数（CVF）,评价心肌纤维化程度。结果 47例冠脉搭桥患者术后有15例发生心房颤动,发生率为31.9%。47例患者心肌CVF平均为21.6%±8.1%（4.1%~39.1%）。分组分析结果显示：房颤组患者的年龄显著大于对照组（P=0.032）;房颤组和对照组心肌CVF分别为25.4%±7.9%和19.9%±7.7%,房颤组显著高于对照组（P=0.020）;两组患者其他术前资料及术中和术后情况无明显差异。相关性分析结果显示患者年龄与心肌CVF显著相关（r=0.876,P=0.007）。结论年龄与心肌纤维化程度明显相关,心房心肌纤维化与冠脉搭桥术后心房颤动的发生相关。心肌纤维化可能是冠脉搭桥术后心房颤动发生的重要机制之一。

Objective To investigate the correlation between atrial fibrosis and atrial fibrillation after coronary artery bypass grafting（CABG）.Methods Forty-seven patients with coronary atherosclerotic heart disease were assigned to the atrial fibrillation group and non-atrial fibrillation group（control group） according to whether atrial fibrillation occurred after CABG.Right atrial appendage sample was harvested before cardiopulmonary bypass.Collagen fiber content in samples was semi-quantitatively measured after Masson staining.Myocardial collagen volume fraction（CVF） in atrial tissues was calculated and atrial fibrosis was assessed.Results Among 47 patients undergoing CABG,15（31.9%） of them developed postoperative atrial fibrillation.Myocardial CVF was 21.6%± 8.1%（4.1%- 39.1%）.Analysis by group showed that the age in the atrial fibrillation group was significantly older than that in the control group（P = 0.032）.Myocardial CVFs in the atrial fibrillation group and the control group were 25.4%± 7.9%and 19.9%± 7.7%,respectively.Myocardial CVF in the atrial fibrillation group was significantly higher than that in the control group（P =0.020）.The differences in other preoperative,intraoperative and postoperative data between two groups were not markedly.Correlation analysis showed that the age of patients was significantly correlated to myocardial CVF（r = 0.876,P = 0.007）.Conclusion T he age is significantly correlated to atrial fibrosis and atrial fibrosis is correlated to atrial fibrillation after CABG.Atrial fibrosis may be one of important mechanisms of developing atrial fibrillation after CABG.