全胸腹主动脉置换术患者围术期神经损伤标志物及炎性因子的浓度变化  

Perioperative Changes of Biomarkers and Cytokines in Cerebrospinal Fluid of Patients Undergoing Thoracoabdominal Aortic Aneurysm Repair

作　　者：董秀华 王嵘 金沐 杨彦伟 王岳锋 马月华 卢家凯 程卫平 DONG Xiu-hua, WANG Rong, JIN Mu, YANG Yan-wei, WANG Yue-feng, MA Yue-hua, LU Jia-kai, CHENG Wei-ping(Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessels Diseases, Beijing （100029）, China)

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所麻醉科,北京市100029

出　　处：《中国循环杂志》2018年第7期705-708,共4页Chinese Circulation Journal

基　　金：国家卫生和计划生育委员会-公益性行业科研专项项目(201402009);科技部国家科技支撑计划(2015BAI12B03);北京市自然科学基金资助项目(7152046)

摘　　要：目的:探讨全胸腹主动脉置换术(TAAAR)患者围术期神经损伤标志物及炎性因子的浓度变化。方法:选取45例接受TAAAR的全胸腹主动脉瘤患者,分别于切皮前、术毕、术后第1d、术后第2 d抽取脑脊液标本,采用酶联免疫吸附(ELISA)法检测神经元特异性烯醇化酶(NSE)、S100β蛋白、胶质纤维酸性蛋白(GFAP)、离子钙接头蛋白1(Iba1)、髓鞘碱性蛋白(MBP)、白细胞介素-10(IL-10)、基质金属蛋白酶-9(MMP-9)的浓度变化。结果:围术期脑脊液NSE、S100β蛋白、GFAP、IL-10及MMP-9水平在术毕时达到浓度峰值(P均<0.05)。与切皮前比较,NSE、S100β蛋白、GFAP、IL-10水平在术毕时及术后1d时点升高,MMP-9水平仅在术毕时升高,差异均具有统计学意义(P均<0.05)。结论:TAAAR患者脑脊液中多种神经损伤标志物及炎性因子水平在术毕及术后1d显著升高,其浓度峰值发生于术毕,提示脊髓损伤反应高峰位于术毕,应在术中、术后采取必要措施,以减轻脊髓损伤反应及并发症发生。Objectives：To explore the perioperative changes of biomarkers and cytokines in the cerebrospinal fluid of patients undergoing thoracoabdominal aortic aneurysm repair surgery. Methods：The samples of cerebrospinal fluid of 45 patients undergoing thoracoabdominal aortic aneurysm repair surgery were obtained at the time of pre-incision, end of operation, 1-day and 2-day post operation. The levels of neuron specific enolase（NSE）, calcium-binding protein S100β, glial fibrillary acidic protein（GFAP）, ionized calcium-binding adaptor molecule 1（Iba1）, myelin basic protein（MBP）, interleukin 10（IL-10）, and matrix metalloproteinase 9（MMP-9） were measured by enzyme-linked immunosorbent assays（ELISA）.Results： Values of NSE, S100β, GFAP, IL-10 and MMP-9 peaked at the end of the operation. When compared with preincision level, NSE, S100β, GFAP and IL-10 increased significantly at the end of operation and on the 1 st operative day（P〈0.01 or P〈0.05）, and MMP-9 level was also significantly increased at the end of operation compared to pre-incision level（P〈0.01）. The level of Iba1 and MBP did not altered significantly（P〈0.05） during the perioperative period. Conclusions：The biomarkers and cytokines in the cerebrospinal fluid increased significantly at the end of operation and on the 1 st post operation day in patients undergoing thoracoabdominal aortic aneurysm repair surgery, and the peak level was observed at the end of operation, indicating that the spinal cord injury peaked at the end of the operation. It is necessary to take measures to relieve the spinal cord injury during the perioperative period.

关 键 词：全胸腹主动脉置换术 脑脊液 神经损伤标志物 炎性因子 

分 类 号：R541[医药卫生—心血管疾病]