一项关于与颈动脉血运重建相关的全身生物标志物和认知功能的前瞻性评估。
A Prospective Evaluation of Systemic Biomarkers and Cognitive Function Associated with Carotid Revascularization.
作者信息
Zuniga Mary C, Tran Thuy B, Baughman Brittanie D, Raghuraman Gayatri, Hitchner Elizabeth, Rosen Allyson, Zhou Wei
机构信息
*VA Palo Alto Health Care System, Palo Alto, CA †Department of Surgery, Stanford University, Stanford, CA ‡Department of Psychiatry, Stanford University, Stanford, CA.
出版信息
Ann Surg. 2016 Oct;264(4):659-65. doi: 10.1097/SLA.0000000000001853.
OBJECTIVE
To determine factors affecting cognition and identify predictors of long-term cognitive impairment following carotid revascularization procedures.
BACKGROUND
Cognitive impairment is common in older patients with carotid occlusive diseases.
METHODS
Patients undergoing carotid intervention for severe occlusive diseases were prospectively recruited. Patients received neurocognitive testing before, 1, and 6 months after carotid interventions. Plasma samples were also collected within 24 hours after carotid intervention and inflammatory cytokines were analyzed. Univariate and multivariate logistic regressions were performed to identify risk factors associated with significant cognitive deterioration (>10% decline).
RESULTS
A total of 98 patients (48% symptomatic) were recruited, including 55 patients receiving carotid stenting and 43 receiving endarterectomy. Mean age was 69 (range 54-91 years). Patients had overall improvement in cognitive measures 1 month after revascularization. When compared with carotid stenting, endarterectomy patients demonstrated postoperative improvement in cognition at 1 and 6 months compared with baseline. Carotid stenting (odds ratio 6.49, P = 0.020) and age greater than 80 years (odds ratio 12.6, P = 0.023) were associated with a significant long-term cognitive impairment. Multiple inflammatory cytokines also showed significant changes after revascularization. On multivariate analysis, after controlling for procedure and age, IL-12p40 (P = 0.041) was associated with a higher risk of significant cognitive impairment at 1 month; SDF1-α (P = 0.004) and tumor necrosis factor alpha (P = 0.006) were independent predictors of cognitive impairment, whereas interleukin-6 (P = 0.019) demonstrated cognitive protective effects at 6 months after revascularization.
CONCLUSIONS
Carotid interventions affect cognitive function. Systemic biomarkers can be used to identify patients at risk of significant cognitive decline postprocedures that benefit from targeted cognitive training.
目的
确定影响认知的因素，并识别颈动脉血运重建术后长期认知障碍的预测因素。
背景
认知障碍在老年颈动脉闭塞性疾病患者中很常见。
方法
前瞻性招募因严重闭塞性疾病接受颈动脉干预的患者。患者在颈动脉干预前、干预后1个月和6个月接受神经认知测试。在颈动脉干预后24小时内还采集了血浆样本，并分析了炎性细胞因子。进行单因素和多因素逻辑回归以识别与显著认知恶化（下降>10%）相关的危险因素。
结果
共招募了98例患者（48%有症状），包括55例行颈动脉支架置入术的患者和43例行内膜切除术的患者。平均年龄为69岁（范围54 - 91岁）。血运重建术后1个月患者的认知指标总体有所改善。与颈动脉支架置入术相比，内膜切除术患者在术后1个月和6个月时与基线相比认知有改善。颈动脉支架置入术（比值比6.49，P = 0.020）和年龄大于80岁（比值比12.6，P = 0.023）与显著的长期认知障碍相关。多种炎性细胞因子在血运重建后也显示出显著变化。多因素分析显示，在控制手术和年龄因素后，白细胞介素-12p40（IL-12p40，P = 0.041）与术后1个月显著认知障碍风险较高相关；基质细胞衍生因子1-α（SDF1-α，P = 0.004）和肿瘤坏死因子α（P = 0.006）是认知障碍的独立预测因素，而白细胞介素-6（P = 0.019）在血运重建术后6个月显示出认知保护作用。
结论
颈动脉干预会影响认知功能。系统性生物标志物可用于识别术后有显著认知下降风险的患者，这些患者可从针对性的认知训练中获益。
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