C 反应蛋白水平与心脏瓣膜置换术后认知功能障碍发生的相关性研究。
An Association Between C-Reactive Protein Levels and the Occurrence of Cognitive Dysfunction After Heart Valve Replacement.
机构信息
Department of Anesthesiology and Intensive Care, Diponegoro University Faculty of Medicine/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia.
Department of Neurosurgery, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital, Semarang City, Central Java Province, Indonesia.
出版信息
Vasc Health Risk Manag. 2021 Nov 19;17:713-720. doi: 10.2147/VHRM.S334982. eCollection 2021.
BACKGROUND
Postoperative cognitive dysfunction (POCD) is defined as cognitive dysfunction related to inflammation after surgical procedures, which is common following cardiac surgery. Cognitive deficits are thought to result from a systemic inflammatory response. C-reactive protein (CRP) and other proinflammatory cytokines, which are released in response to inflammation, disrupt the blood-brain barrier and neurotransmission, resulting in POCD. This study aimed to determine the correlation between POCD and increased levels of CRP in patients who had undergone heart valve replacement.
METHODS
This study comprised 32 patients with normal cognitive function undergoing heart valve replacement. The CRP levels were measured before surgery and on the second postoperative day, and cognitive function was examined via the Indonesian-adapted Montreal Cognitive Assessment (MOCA-INA) on the third postoperative day. Data were analyzed using Spearman correlation test.
RESULTS
Of the 32 patients, 28 (87.5%) experienced POCD. The median level of CRP was 6.6 mg/dL (interquartile range: 4.0, 8.3 g/dL). According to Spearman correlation test, increased levels of CRP were significantly related to POCD following heart valve replacement (p = 0.003, r = 0.501). The receiver operating characteristic curve indicated that the CRP cutoff level was 3.345 mg/dL, and the sensitivity and specificity were 89.3% and 75%, respectively.
CONCLUSION
High expression level of CRP was correlated with POCD following heart valve replacement.
背景
术后认知功能障碍（POCD）被定义为与手术后炎症相关的认知功能障碍，这在心脏手术后很常见。认知缺陷被认为是全身炎症反应的结果。C 反应蛋白（CRP）和其他促炎细胞因子在炎症反应中释放，破坏血脑屏障和神经传递，导致 POCD。本研究旨在确定接受心脏瓣膜置换术的患者中 POCD 与 CRP 水平升高之间的相关性。
方法
本研究纳入 32 例认知功能正常的行心脏瓣膜置换术患者。在术前和术后第 2 天测量 CRP 水平，在术后第 3 天通过印度尼西亚改编的蒙特利尔认知评估（MOCA-INA）检查认知功能。使用 Spearman 相关检验分析数据。
结果
32 例患者中，28 例（87.5%）发生 POCD。CRP 的中位数水平为 6.6 mg/dL（四分位距：4.0，8.3 g/dL）。根据 Spearman 相关检验，心脏瓣膜置换术后 CRP 水平升高与 POCD 显著相关（p = 0.003，r = 0.501）。受试者工作特征曲线表明 CRP 的截断值为 3.345 mg/dL，灵敏度和特异性分别为 89.3%和 75%。
结论
CRP 高表达水平与心脏瓣膜置换术后 POCD 相关。
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