Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany.
Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany.
BMC Anesthesiol. 2024 Oct 8;24(1):358. doi: 10.1186/s12871-024-02722-3.
Endothelial dysfunction (ED) promotes the development of atherosclerosis, and studies suggest an association with age-related neurocognitive disorders. It is currently unclear whether ED is also associated with the risk of perioperative neurocognitive disorders.
We included 788 participants aged ≥ 65 years of the BioCog study. Patients were scheduled to undergo elective surgery with expected duration > 60 min. Blood was collected before surgery for measurement of 5 biomarkers of ED: asymmetric and symmetric dimethylarginine (ADMA; SDMA), intercellular and vascular adhesion molecule (ICAM-1, VCAM-1), and von Willebrand factor (vWF). Patients were monitored for the occurrence of postoperative delirium (POD) daily until the 7th postoperative day. 537 (68.1%) patients returned for a 3-month follow-up. Post-operative cognitive dysfunction (POCD) was defined from the change in results on a battery of 6 neuropsychological tests between baseline and 3 months, compared to the change in results of a control group during the 3-month interval. The associations of each of the 5 ED biomarkers with POD and POCD respectively were determined using multiple logistic regression analyses with adjustment for age, sex, surgery type, pre-morbid IQ, body mass index, hypertension, diabetes, HbA1C, triglyceride, total and HDL cholesterol.
19.8% of 788 patients developed POD; 10.1% of 537 patients had POCD at 3 months. Concentrations of ED biomarkers were not significantly associated with a POD. A higher VCAM-1 concentration was associated with a reduced POCD risk (adjusted odds ratio 0.55; 95% CI: 0.35-0.86). No further statistically significant results were found.
Pre-operative concentrations of ED biomarkers were not associated with POD risk. We unexpectedly found higher VCAM-1 to be associated with a reduced POCD risk. Further studies are needed to evaluate these findings.
内皮功能障碍（ED）可促进动脉粥样硬化的发展，有研究表明其与年龄相关的神经认知障碍有关。目前尚不清楚 ED 是否也与围手术期神经认知障碍的风险相关。
我们纳入了 788 名年龄≥65 岁的 BioCog 研究参与者。这些患者拟接受预计持续时间>60 分钟的择期手术。手术前采集血液，以测量 5 种 ED 生物标志物：非对称和对称二甲基精氨酸（ADMA；SDMA）、细胞间和血管黏附分子（ICAM-1、VCAM-1）和血管性血友病因子（vWF）。每天监测患者是否发生术后谵妄（POD），直至术后第 7 天。537 名（68.1%）患者在 3 个月后进行了随访。术后认知功能障碍（POCD）是通过与对照组在 3 个月间隔内的结果相比，在基线和 3 个月之间的 6 项神经心理学测试结果的变化来定义的。使用多元逻辑回归分析，分别调整年龄、性别、手术类型、术前智商、体重指数、高血压、糖尿病、HbA1C、甘油三酯、总胆固醇和高密度脂蛋白胆固醇，以确定 5 种 ED 生物标志物中的每一种与 POD 和 POCD 的相关性。
788 名患者中有 19.8%发生 POD；537 名患者中有 10.1%在 3 个月时发生 POCD。ED 生物标志物的浓度与 POD 无显著相关性。较高的 VCAM-1 浓度与降低 POCD 风险相关（调整后的优势比 0.55；95%CI：0.35-0.86）。未发现进一步具有统计学意义的结果。
术前 ED 生物标志物的浓度与 POD 风险无关。我们意外地发现，较高的 VCAM-1 与降低 POCD 风险相关。需要进一步的研究来评估这些发现。
