Tang Ni, Jiang Rongrong, Wang Xiaobin, Wen Jian, Liu Li, Wu Jiali, Zhang Chunxiang
Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China.
Department of Anesthesiology, Pi County People's Hospital, Chengdu, Sichuan Province 646000, China.
Brain Res. 2017 Feb 15;1657:377-382. doi: 10.1016/j.brainres.2016.12.027. Epub 2016 Dec 31.
Severe insulin resistance (IR) promotes the development of Alzheimer disease. IR and postoperative cognitive dysfunction (POCD) are a common complication during the cardiac perioperative period. The authors hypothesized that IR of individuals with cardiac valve surgery would have increased the risk of POCD. The purpose of the study was to analyze the association of IR and POCD after cardiac valve surgery. Total 131 patients who underwent valve replacement via cardiopulmonary bypass (CPB) were included. Cognitive function was assessed by a series of neuropsychological measurements at 1day before and 7days after the surgery. 40 healthy volunteers as the control group also completed the neuropsychological assessment at the same time point. POCD was identified using the "Z score" method. Fasting blood glucose and insulin levels were detected before anesthesia and at 6h and 7days post-operation. Additionally serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) were measured at 6h post-operation. The insulin resistance index was calculated by "homeostasis model assessment 2" (HOMA2) software. The relationship between IR and POCD or TNF-α, IL-6 was then analyzed. At 7days after surgery, the incidence of POCD was 43.8%. The levels of HOMA2-IR in patients with POCD were significantly higher than those of patients without POCD at 6h and 7days after operation (P<0.05).The levels of serum IL-6 and TNF- α were positively correlated with HOMA2-IR value at 6h after operation (RIL-6=0.426, P<0.01; RTNF-a=0.381, P<0.01). POCD was correlated with the patients' education age (OR=1.062), CPB time (OR=1.018), self-rating depression scale (SDS) score after operation (OR=1.082), HOMA2-IR at 6h (OR=1.110) and 7days (OR=13.762) after operation, IL-6 (OR=1.036) and TNF-α (OR=1.039) at 6h after operation. Our study suggests that IR is correlated with the incidence of POCD and the increase of inflammatory factors.
严重胰岛素抵抗（IR）会促进阿尔茨海默病的发展。IR和术后认知功能障碍（POCD）是心脏围手术期常见的并发症。作者推测，心脏瓣膜手术患者的IR会增加POCD的风险。本研究的目的是分析心脏瓣膜手术后IR与POCD之间的关联。总共纳入了131例接受体外循环（CPB）瓣膜置换术的患者。在手术前1天和手术后7天通过一系列神经心理学测量评估认知功能。40名健康志愿者作为对照组也在同一时间点完成了神经心理学评估。使用“Z评分”方法确定POCD。在麻醉前以及术后6小时和7天检测空腹血糖和胰岛素水平。此外，在术后6小时测量血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平。胰岛素抵抗指数通过“稳态模型评估2”（HOMA2）软件计算。然后分析IR与POCD或TNF-α、IL-6之间的关系。术后7天，POCD的发生率为43.8%。POCD患者术后6小时和7天的HOMA2-IR水平显著高于无POCD患者（P<0.05）。术后6小时血清IL-6和TNF-α水平与HOMA2-IR值呈正相关（RIL-6=0.426，P<0.01；RTNF-a=0.381，P<0.01）。POCD与患者的受教育年限（OR=1.062）、CPB时间（OR=1.018）、术后自评抑郁量表（SDS）评分（OR=1.082）、术后6小时（OR=1.110）和7天（OR=13.762）的HOMA2-IR、术后6小时的IL-6（OR=1.036）和TNF-α（OR=1.039）相关。我们的研究表明，IR与POCD的发生率以及炎症因子的增加相关。
