心脏手术后 18F-氟比他滨正电子发射断层扫描测定的脑β-淀粉样蛋白沉积与神经认知表现。
18F-florbetapir Positron Emission Tomography-determined Cerebral β-Amyloid Deposition and Neurocognitive Performance after Cardiac Surgery.
机构信息
From the Department of Anesthesiology (R.Y.K., T.B., M.B., N.T., M.F.N., J.P.M.), Department of Radiology (O.G.J., S.B.-N.), Department of Biostatistics and Bioinformatics (Y.-J.L., W.Q.), and the Department of Psychiatry and Behavioral Science (P.M.D.), Duke University, Durham, North Carolina. University of California, San Francisco University of Southern California University of California, San Francisco University of Southern California Mayo Clinic, Rochester Mayo Clinic, Rochester University of California, Berkeley University of Pennsylvania University of Southern California University of California, Davis Brigham and Women's Hospital/Harvard Medical School Indiana University Washington University St. Louis University of Pennsylvania Prevent Alzheimer's Disease 2020 (Chair) Siemens Alzheimer's Association University of Pittsburgh Washington University St. Louis Cornell University Albert Einstein College of Medicine of Yeshiva University AD Drug Discovery Foundation Acumen Pharmaceuticals Washington University St. Louis Northwestern University National Institute of Mental Health Brown University Eli Lilly (Chair) BWH/HMS (Chair) University of Washington (Chair) Mayo Clinic, Rochester (Core Principal Investigator) University of Southern California University of California, San Diego University of California, San Diego University of California, San Diego University of California, San Diego University of California, San Diego University of California, San Diego University of California, San Diego University of California, San Diego University of California, San Diego University of California, Davis (Core Principal Investigator) University of California, Davis University of California, San Diego Mayo Clinic, Rochester (Core Principal Investigator) Mayo Clinic, Rochester University of London University of California, Los Angeles School of Medicine University of California, San Francisco Magnetic Resonance Imaging University of California, Davis Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic Mayo Clinic University of California, Berkeley (Core Principal Investigator) University of Michigan University of Utah Banner Alzheimer's Institute Banner Alzheimer's Institute University of Pittsburgh University of California, Berkeley Washington 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出版信息
Anesthesiology. 2018 Apr;128(4):728-744. doi: 10.1097/ALN.0000000000002103.
BACKGROUND
Amyloid deposition is a potential contributor to postoperative cognitive dysfunction. The authors hypothesized that 6-week global cortical amyloid burden, determined by F-florbetapir positron emission tomography, would be greater in those patients manifesting cognitive dysfunction at 6 weeks postoperatively.
METHODS
Amyloid deposition was evaluated in cardiac surgical patients at 6 weeks (n = 40) and 1 yr (n = 12); neurocognitive function was assessed at baseline (n = 40), 6 weeks (n = 37), 1 yr (n = 13), and 3 yr (n = 9). The association of 6-week amyloid deposition with cognitive dysfunction was assessed by multivariable regression, accounting for age, years of education, and baseline cognition. Differences between the surgical cohort with cognitive deficit and the Alzheimer's Disease Neuroimaging Initiative cohorts (normal and early/late mild cognitive impairment) was assessed, adjusting for age, education, and apolipoprotein E4 genotype.
RESULTS
The authors found that 6-week abnormal global cortical amyloid deposition was not associated with cognitive dysfunction (13 of 37, 35%) at 6 weeks postoperatively (median standard uptake value ratio [interquartile range]: cognitive dysfunction 0.92 [0.89 to 1.07] vs. 0.98 [0.93 to 1.05]; P = 0.455). In post hoc analyses, global cortical amyloid was also not associated with cognitive dysfunction at 1 or 3 yr postoperatively. Amyloid deposition at 6 weeks in the surgical cohort was not different from that in normal Alzheimer's Disease Neuroimaging Initiative subjects, but increased over 1 yr in many areas at a rate greater than in controls.
CONCLUSIONS
In this study, postoperative cognitive dysfunction was not associated with 6-week cortical amyloid deposition. The relationship between cognitive dysfunction and regional amyloid burden and the rate of postoperative amyloid deposition merit further investigation.
背景
淀粉样蛋白沉积是术后认知功能障碍的潜在原因。作者假设，通过 F-氟比洛芬正电子发射断层扫描（PET）确定的 6 周时的皮质整体淀粉样蛋白负荷，在术后 6 周时表现出认知功能障碍的患者中会更高。
方法
在心脏手术患者中，在 6 周（n=40）和 1 年（n=12）时评估淀粉样蛋白沉积情况；在基线（n=40）、6 周（n=37）、1 年（n=13）和 3 年（n=9）时评估神经认知功能。通过多变量回归评估 6 周时的淀粉样蛋白沉积与认知功能障碍的相关性，考虑了年龄、受教育年限和基线认知功能。在调整年龄、教育程度和载脂蛋白 E4 基因型后，评估了有认知缺陷的手术队列与阿尔茨海默病神经影像学倡议队列（正常和早期/晚期轻度认知障碍）之间的差异。
结果
作者发现，6 周时异常的皮质整体淀粉样蛋白沉积与术后 6 周时的认知功能障碍（37 例中的 13 例，35%）无关（标准摄取值比值中位数[四分位距]：认知功能障碍组 0.92[0.89 至 1.07] vs. 0.98[0.93 至 1.05]；P=0.455）。在事后分析中，皮质整体淀粉样蛋白也与术后 1 年或 3 年的认知功能障碍无关。手术队列中的淀粉样蛋白沉积与正常阿尔茨海默病神经影像学倡议参与者的淀粉样蛋白沉积无差异，但在许多区域在 1 年内增加，增加速度快于对照组。
结论
在本研究中，术后认知功能障碍与 6 周时的皮质淀粉样蛋白沉积无关。认知功能障碍与区域性淀粉样蛋白负荷及术后淀粉样蛋白沉积的速度之间的关系值得进一步研究。
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