Postoperative troponin increases after noncardiac surgery are associated with raised neurofilament light: a prospective observational cohort study.
Postoperative troponin increases after noncardiac surgery are associated with raised neurofilament light: a prospective observational cohort study.
复制标题
非心脏手术后术后肌钙蛋白增加与神经丝光升高相关：一项前瞻性观察队列研究。
DOI：
10.1016/j.bja.2020.10.012
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发表时间：
2021
影响因子：
9.8
通讯作者：
Lennertz,Richard
中科院分区：
文献类型：
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作者：
Sanders,RobertD;Craigova,Lenka;Schessler,Benjamin;Casey,Cameron;White,Marissa;Parker,Margaret;Kunkel,David;Blennow,Kaj;Zetterberg,Henrik;Pearce,RobertA;Lennertz,Richard
背景非心脏手术后常发生心肌和神经元损伤。我们研究了围术期心肌损伤(PMI)患者是否也发生了神经元损伤，以及心肌和神经元损伤是否与炎症标志物的相似变化或重叠的临床预测因素相关。方法从两项正在进行的围术期队列研究(NCT02926417；NCT03124303)中招募了114名65岁的老年人。分别于手术前和术后每日采集血浆样本，检测肌钙蛋白I(PMI)、神经细丝光(NFL；神经元损伤)和多种血浆细胞因子(炎症)。主要结果是患有肥厚性心肌梗死的患者的NFL的改变(>；40pgml−1肌钙蛋白高于术前值)。我们进行Logistic回归分析，以确定是否存在共同的心肌和神经元损伤的临床预测因素。结果96名患者的NFL和肌钙蛋白数据配对。与无肌钙蛋白升高的受试者(8pgml−1[3-20]；1.3倍；P=0.008)相比，有肌钙蛋白增高者中有23例(24%)NFL增加(中位数[四分位数范围]：29pgml−1[3-95pgml−1]；增加2.8倍)。PMI与IL-1ra(P=0.005)、IL-2(P=0.045)、IL-8(P=0.002)和IL-10(P=0.001)升高有关。Logistic回归分析显示，术中低血压与PMI相关(P=0.043)。术前卒中(P=0.041)和失血(P=0.002)与NFL升高有关，而术中低血压与NFL升高无关。结论术后肌钙蛋白升高与NFL和炎性细胞因子的变化有关。肌钙蛋白的升高，而不是NFL，与术中低血压有关，这表明导致神经元和心肌损伤的机制不同。
BackgroundMyocardial and neuronal injury occur commonly after noncardiac surgery. We examined whether patients who had perioperative myocardial injury (PMI) also incurred neuronal injury, and whether myocardial and neuronal injury were associated with similar changes in inflammatory markers or overlapping clinical predictors.MethodsA total of 114 individuals >65 yr old were recruited from two ongoing perioperative cohort studies (NCT02926417; NCT03124303). Plasma samples were collected before and daily after surgery to process assays for troponin I (PMI), neurofilament light (NfL; neuronal injury) and multiplexed plasma cytokines (inflammation). The primary outcome was the change in NfL in individuals with PMI (>40 pg ml−1increase in troponin above preoperative values). We conducted logistic regression to identify if there were shared clinical predictors for myocardial and neuronal injury.ResultsNinety-six patients had paired NfL and troponin data. Twenty-three of 94 subjects (24%) with PMI had greater increases in NfL (median [inter-quartile range, IQR]: 29 pg ml−1[3–95 pg ml−1]; 2.8-fold increase) compared with subjects with no troponin increase (8 pg ml−1[3–20]; 1.3-fold increase;P=0.008). PMI was associated with increased interleukin (IL)-1ra (P=0.005), IL-2 (P=0.045), IL-8 (P=0.002), and IL-10 (P<0.001). Logistic regression showed that intraoperative hypotension was associated with PMI (P=0.043). Preoperative stroke (P=0.041) and blood loss (P=0.002), but not intraoperative hypotension, were associated with increased NfL.ConclusionsPostoperative troponin increases were associated with changes in NfL and inflammatory cytokines. Increases in troponin, but not NfL, were associated with intraoperative hypotension, suggesting differences in the mechanisms contributing to neuronal and myocardial injury.