术前认知功能以及心脏手术的炎症和神经内分泌反应
Pre-Operative Cognitive Functioning and Inflammatory and Neuroendocrine Responses to Cardiac Surgery.
作者信息
Poole Lydia, Ronaldson Amy, Kidd Tara, Leigh Elizabeth, Jahangiri Marjan, Steptoe Andrew
机构信息
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
Department of Cardiac Surgery, St George's Hospital, University of London, Blackshaw Road, London, SW17 0QT, UK.
出版信息
Ann Behav Med. 2016 Aug;50(4):545-53. doi: 10.1007/s12160-016-9779-7.
BACKGROUND
Cognitive functioning is linked to cardiac mortality and morbidity, but the mechanisms underlying this relationship are unclear.
PURPOSE
To examine the relationship between pre-operative cognitive functioning and post-operative inflammatory and neuroendocrine responses in patients undergoing coronary artery bypass graft (CABG) surgery.
METHODS
One-hundred ninety-three outpatients were screened to assess their cognitive function using the Montreal Cognitive Assessment (MoCA) on average 30 days prior to CABG surgery and provided blood samples for the measurement of interleukin (IL)-6 and C-reactive protein (CRP) and saliva samples for the measurement of diurnal cortisol. Participants were followed-up 4-8 days following surgery for the repeat measurement of IL-6 and CRP and 60 days after surgery for the measurement of diurnal salivary cortisol.
RESULTS
Patients with low cognitive function (MoCA < 26) prior to surgery reached higher IL-6 concentrations in the days after surgery (β = -0.212, p = 0.021) and had greater cortisol output across the day 2 months after surgery (β = -0.179, p = 0.044).
CONCLUSIONS
Low cognitive functioning is associated with a more negative pattern of biological response to surgery, indicative of poorer physical recovery. These pathways may contribute to the links between cognitive function and cardiovascular pathology.
背景
认知功能与心脏死亡率和发病率相关，但这种关系背后的机制尚不清楚。
目的
研究冠状动脉旁路移植术（CABG）患者术前认知功能与术后炎症和神经内分泌反应之间的关系。
方法
对193名门诊患者进行筛查，在CABG手术前平均30天使用蒙特利尔认知评估量表（MoCA）评估其认知功能，并采集血样测定白细胞介素（IL）-6和C反应蛋白（CRP），采集唾液样本测定昼夜皮质醇。术后4-8天对参与者进行随访，重复测量IL-6和CRP；术后60天测量昼夜唾液皮质醇。
结果
术前认知功能低下（MoCA＜26）的患者术后数天IL-6浓度更高（β=-0.212，p=0.021），术后2个月全天皮质醇分泌量更大（β=-0.179，p=0.044）。
结论
认知功能低下与对手术的生物学反应更消极模式相关，表明身体恢复较差。这些途径可能有助于认知功能与心血管病理之间的联系。
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