Department of Clinical Immunology, Medical University of Bialystok Clinical Hospital, Bialystok, Poland.
Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
J Alzheimers Dis. 2020;74(4):1211-1220. doi: 10.3233/JAD-191165.
Anesthesia and surgery is commonly associated with central nervous system sequelae and cognitive symptoms, which may be caused by neuronal injury. Neuronal injury can be monitored by plasma concentrations of the neuronal biomarkers tau and neurofilament light protein (NFL). Currently, there are no studies examining whether neuronal injury varies between surgical procedures.
Our aim was to investigate if neuronal damage is more frequent after cardiac than after otolaryngeal surgery, as estimated by tau and NFL concentrations in plasma.
Blood samples were drawn before, during, and after surgery and concentrations of tau, NFL, Aβ40, and Aβ42 were measured in 25 patients undergoing cardiac surgery (9 off-pump and 16 on-pump) and 26 patients undergoing otolaryngeal surgery.
Tau increased during surgery (1752%, p = 0.0001) and NFL rose seven days post-surgery (1090%, p < 0.0001) in patients undergoing cardiac surgery; even more in patients on-pump than off-pump. No changes were observed in patients undergoing otolaryngeal surgery and only minor fluctuations were observed for Aβ40 and Aβ42.
Cardiac surgery is associated with neuronal injury, which is aggravated by extracorporeal circulation. Analyses of NFL and tau in blood may guide development of surgical procedures to minimize neuronal damage, and may also be used in longitudinal clinical studies to assess the relationship of surgery with future neurocognitive impairment or dementia.
麻醉和手术通常与中枢神经系统后遗症和认知症状相关，这些可能是由神经元损伤引起的。神经元损伤可以通过神经元生物标志物 tau 和神经丝轻链蛋白（NFL）的血浆浓度来监测。目前，尚无研究探讨不同手术程序之间神经元损伤是否存在差异。
我们旨在通过检测血浆中 tau 和 NFL 浓度，来研究心脏手术与耳鼻喉手术相比，是否更易引起神经元损伤。
在 25 例行心脏手术（9 例非体外循环和 16 例体外循环）和 26 例行耳鼻喉手术的患者中，分别在术前、术中及术后采集血样，并检测 tau、NFL、Aβ40 和 Aβ42 的浓度。
心脏手术患者的 tau 在手术期间增加（1752%，p=0.0001），NFL 在术后 7 天升高（1090%，p<0.0001）；体外循环组比非体外循环组升高更明显。耳鼻喉手术患者未观察到变化，Aβ40 和 Aβ42 仅观察到轻微波动。
心脏手术与神经元损伤有关，体外循环会加重这种损伤。血液中 NFL 和 tau 的分析可能有助于指导手术程序的改进，以最大程度地减少神经元损伤，并且还可用于纵向临床研究，以评估手术与未来神经认知障碍或痴呆的关系。
