Serum glial cell line-derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart disease
Serum glial cell line-derived neurotrophic factor levels and postoperative cognitive dysfunction after surgery for rheumatic heart disease
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DOI：
10.1016/j.jtcvs.2017.07.073
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发表时间：
2018-03-01
影响因子：
6
通讯作者：
Wang, Xiaobin
中科院分区：
文献类型：
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作者：
Duan, Xiaoxia;Zhu, Tao;Wang, Xiaobin
目的：术后认知功能障碍是心脏手术的重要并发症，预后较差。阿尔茨海默病患者血清胶质细胞源性神经营养因子水平降低，但胶质细胞源性神经营养因子水平与术后认知功能障碍之间的关系尚不清楚。本研究旨在探讨风湿性心脏病心脏瓣膜置换术患者术后血清胶质细胞源性神经营养因子水平对预测术后认知功能障碍的预后价值。方法：对东南医科大学附属医院2015年6月至2016年6月80例心脏瓣膜置换术患者进行前瞻性观察研究。分别于术前1天和术后7天进行认知功能评定。分别于手术前(T1)、术后第1天(T2)、术后第2天(T3)、术后第7天(T4)用双抗体夹心酶联免疫吸附试验检测血清胶质细胞源性神经营养因子水平。评估围手术期神经营养因子与术后认知功能障碍的关系。结果：38例患者(47.5%)术后7d出现认知功能障碍。术后认知功能障碍组术后第2天和第7天的平均胶质细胞源性神经营养因子水平均低于同期非认知功能障碍组(P<；.001)。Delta胶质细胞源性神经营养因子(T1-T3)和Delta胶质细胞源性神经营养因子(T1-T4)是预测术后认知功能障碍的良好指标，术后认知功能障碍的检测阈值分别为49.10和60.90。结论：术后认知功能障碍患者围手术期血清胶质细胞源性神经营养因子水平低于无认知功能障碍患者。胶质细胞源性神经营养因子可有效预测术后认知功能障碍的发生。这些结果揭示了胶质细胞源性神经营养因子水平降低在术后认知功能障碍中的潜在重要作用，并提供了可能的治疗目标。
Objective: Postoperative cognitive dysfunction is an important complication of cardiac surgery with poor outcomes. Serum glial cell line-derived neurotrophic factor levels are decreased in patients with Alzheimer's disease, but the association between glial cell line-derived neurotrophic factor levels and postoperative cognitive dysfunction is poorly understood. The present study aimed to investigate the prognostic value of postoperative serum glial cell line-derived neurotrophic factor levels to predict postoperative cognitive dysfunction in patients with rheumatic heart disease undergoing heart valve replacement.Methods: This was a prospective observational study of 80 patients undergoing elective heart valve replacement surgery from June 2015 to June 2016 at the Affiliated Hospital of Southeast Medical University. Cognitive functions were assessed 1 day before and 7 days after surgery. Serum glial cell line-derived neurotrophic factor levels were measured by an enzyme-linked immunosorbent assay before (T1) and 1 (T2), 2 (T3), and 7 (T4) days after surgery. Perioperative parameters were evaluated to assess the relationship between glial cell line-derived neurotrophic factors and postoperative cognitive dysfunction.Results: Postoperative cognitive dysfunction was identified in 38 patients (47.5%) 7 days after surgery. Average glial cell line-derived neurotrophic factor levels at 2 and 7 days after surgery in the postoperative cognitive dysfunction group were lower than in the nonpostoperative cognitive dysfunction group at the same time points (P < .001). Delta Glial cell line-derived neurotrophic factor (T1-T3) and Delta glial cell line-derived neurotrophic factor (T1-T4) were identified as good predictors of postoperative cognitive dysfunction with threshold for postoperative cognitive dysfunction detection of 49.10 and 60.90, respectively.Conclusions: The perioperative glial cell line-derived neurotrophic factor levels in patients with postoperative cognitive dysfunction were lower than in patients without postoperative cognitive dysfunction. Glial cell line-derived neurotrophic factor could be an effective predictor for the occurrence of postoperative cognitive dysfunction. The results reveal a potentially important role of decreased glial cell line-derived neurotrophic factor levels in postoperative cognitive dysfunction, with possible treatment targets.