Hansen Jan Hinnerk, Kissner Lydia, Chitadze Guranda, Logoteta Jana, Jung Olaf, Dütschke Peter, Attmann Tim, Scheewe Jens, Kramer Hans-Heiner
Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein-Campus Kiel, Kiel, Germany.
DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
Thorac Cardiovasc Surg. 2019 Dec;67(S 04):e11-e18. doi: 10.1055/s-0039-3401793. Epub 2019 Dec 31.
Neonates undergoing surgery for complex congenital heart disease are at risk of developmental impairment. Hypoxic-ischemic brain injury might be a contributing factor. We aimed to investigate the perioperative release of the astrocyte cytoskeleton component glial fibrillary acid protein and its relation to cerebral oxygenation.
Serum glial fibrillary acid protein levels were measured before and 0, 12, 24, and 48 hours after surgery. Reference values were based on preoperative samples; concentrations above the 95th percentile were defined as elevated. Cerebral oxygenation was derived by near-infrared spectroscopy.
Thirty-six neonates undergoing 38 surgeries utilizing cardiopulmonary bypass were enrolled (complete data available for 35 procedures). Glial fibrillary acid protein was elevated after 18 surgeries (arterial switch: 7/12; Norwood: 5/15; others: 6/8; = 0.144). Age at surgery was higher in cases with elevated serum levels (6 [4-7] vs. 4 [2-5] days, = 0.009) and intraoperative cerebral oxygen saturation was lower (70 ± 10% vs. 77 ± 7%, = 0.029). In cases with elevated postoperative glial fibrillary acid protein, preoperative cerebral oxygen saturation was lower for neonates undergoing the arterial switch operation (55 ± 9% vs. 64 ± 4%, = 0.048) and age at surgery was higher for neonates with a Norwood procedure (7 [6-8] vs. 5 [4-6] days, = 0.028).
Glial fibrillary acid protein was elevated after ∼50% of neonatal cardiac surgeries and was related to cerebral oxygenation and older age at surgery. The potential value as a biomarker for cerebral injury after neonatal cardiac surgery warrants further investigation; in particular, the association with neurodevelopmental outcome needs to be determined.
接受复杂先天性心脏病手术的新生儿有发育受损的风险。缺氧缺血性脑损伤可能是一个促成因素。我们旨在研究围手术期星形胶质细胞细胞骨架成分胶质纤维酸性蛋白的释放及其与脑氧合的关系。
在手术前以及手术后0、12、24和48小时测量血清胶质纤维酸性蛋白水平。参考值基于术前样本；高于第95百分位数的浓度被定义为升高。脑氧合通过近红外光谱法得出。
36例接受38次体外循环心脏手术的新生儿被纳入研究（35例手术有完整数据）。18例手术后胶质纤维酸性蛋白升高（动脉调转术：7/12；诺伍德手术：5/15；其他手术：6/8；P = 0.144）。血清水平升高的病例手术时年龄较大（6[4 - 7]天 vs. 4[2 - 5]天，P = 0.009），术中脑氧饱和度较低（70±10% vs. 77±7%，P = 0.029）。在术后胶质纤维酸性蛋白升高的病例中，接受动脉调转术的新生儿术前脑氧饱和度较低（55±9% vs. 64±4%，P = 0.048），接受诺伍德手术的新生儿手术时年龄较大（7[6 - 8]天 vs. 5[4 - 6]天，P = 0.028）。
约50%的新生儿心脏手术后胶质纤维酸性蛋白升高，且与脑氧合及手术时年龄较大有关。作为新生儿心脏手术后脑损伤生物标志物的潜在价值值得进一步研究；特别是，需要确定其与神经发育结局的关联。
