Zhang Kai, Wang Zhu, Zhu Kai, Dong Songbo, Pan Xudong, Sun Lizhong, Li Qing
Department of Cardiothoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Jiangsu Provincial Institute of Health Emergency, Xuzhou Medical University, Xuzhou, China.
Front Cardiovasc Med. 2021 Nov 11;8:754801. doi: 10.3389/fcvm.2021.754801. eCollection 2021.
Although great progress has been made in surgery and perioperative care, stroke is still a fatal complication of acute type A aortic dissection (ATAAD). Serum biomarkers may help assess brain damage and predict patient's prognosis. From March, 2019 to January, 2020, a total of 88 patients underwent surgical treatment at the Department of Cardiovascular Surgery of Beijing Anzhen Hospital, China, and were enrolled in this study. Patients were divided into two groups according to whether they had suffered a stroke after the operation. Blood samples were collected at 8 time points within 3 days after surgery to determine the level of S100β, neuron-specific enolase (NSE) and neurofilament light chain protein (NFL). Receiver operating characteristic curves (ROC) were established to explore the biomarker predictive value in stroke. The area under the curve (AUC) was used to quantify the ROC curve. The patient average age was 48.1 ± 11.0 years old and 70 (79.6%) patients were male. Fifteen (17.0%) patients suffered stroke after surgery. The NFL levels of patients in the stroke group at 12 and 24 h after surgery were significantly higher than those in the non-stroke group (all < 0.001). However, the NSE and S100β levels did not differ significantly at any time point between the two groups. The predictive value of NFL was the highest at 12 and 24 h after surgery, and the AUC was 0.834 (95% CI, 0.723-0.951, < 0.001) and 0.748 (95% CI, 0.603-0.894, = 0.004), respectively. Its sensitivity and specificity at 12 h were 86.7 and 71.6%, respectively. The NFL cutoff value for the diagnosis of stroke at 12 h after surgery was 16.042 ng/ml. This study suggests that NFL is an early and sensitive serum marker for predicting post-operative neurological prognosis of ATAAD patients. Further studies, including large-scale prospective clinical trials, are necessary to test whether the NFL can be used as a biomarker for clinical decision-making.
尽管在手术和围手术期护理方面取得了巨大进展，但中风仍然是急性A型主动脉夹层（ATAAD）的致命并发症。血清生物标志物可能有助于评估脑损伤并预测患者的预后。2019年3月至2020年1月，共有88例患者在中国北京安贞医院心血管外科接受手术治疗，并纳入本研究。根据患者术后是否发生中风将其分为两组。在术后3天内的8个时间点采集血样，以测定S100β、神经元特异性烯醇化酶（NSE）和神经丝轻链蛋白（NFL）的水平。建立受试者工作特征曲线（ROC）以探讨生物标志物对中风的预测价值。曲线下面积（AUC）用于量化ROC曲线。患者平均年龄为48.1±11.0岁，70例（79.6%）为男性。15例（17.0%）患者术后发生中风。中风组患者术后12小时和24小时的NFL水平显著高于非中风组（均P<0.001）。然而，两组在任何时间点的NSE和S100β水平均无显著差异。NFL在术后12小时和24小时的预测价值最高，AUC分别为0.834（95%CI，0.723-0.951，P<0.001）和0.748（95%CI，0.603-0.894，P=0.004）。其在12小时时的敏感性和特异性分别为86.7%和71.6%。术后12小时诊断中风的NFL临界值为16.042 ng/ml。本研究表明，NFL是预测ATAAD患者术后神经预后的早期敏感血清标志物。有必要进行进一步研究，包括大规模前瞻性临床试验，以检验NFL是否可作为临床决策的生物标志物。
