S100β蛋白含量对体外循环搭桥老龄患者术后认知的意义  

The significance of S100β protein in elderly patients with postoperative cognitive dysfunction after coronary artery bypass grafting

作　　者：张璐 胡奕瑾 王洪武[1] ZHANG Lu;HU Yijin;WANG Hongwu(Department of Anesthesiology,Taida International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院麻醉科

出　　处：《河北医药》2019年第24期3685-3689,共5页Hebei Medical Journal

基　　金：天津市滨海新区卫生局医药卫生科技项目(编号:2011BHKY003)

摘　　要：目的 分析S100β蛋白含量对体外循环搭桥(on-pump CABG)老龄患者术后认知的意义。方法 选择择期全麻下行on-pump CABG患者106例,年龄≥65岁,ASA Ⅱ~Ⅲ级。分别于术前1 d(T0)、术后7 d(T1)、术后30 d(T3)时点采用简明精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)对患者进行评分。根据评分结果将患者分为认知障碍组(P组,n=21)和对照组(C组,n=85),分别于术前(T4)、手术结束时(T5)、术后1 d(T6)和术后3 d(T7)抽取静脉血,ELISA法测定S100β蛋白含量,分析其与围术期各变量的相关性以及预测发生POCD的最佳临界点值。 结果 与C组比较时,P组S100β蛋白含量升高(P<0.01),且ICU停留时间和住院时间增加(P<0.01);相关分析和回归分析中,S100β蛋白含量与转机时间、阻断时间、移植血管桥数量呈正相关(P<0.01),与MMSE和MoCA评分呈负相关(P<0.01);ROC曲线分析中,S100β蛋白含量最佳阈值是148.66 pg/ml[曲线下面积为0.793(95%CI:0.698~0.898,P<0.001),最大约登指数0.46,敏感度81%,特异度64.7%]。结论 POCD患者体内S100β蛋白含量显著增加,当S100β蛋白含量>148.66 pg/ml是POCD一个可靠的预警因子。Objective To investigate significance of S100β protein in elderly patients with postoperative cognitive dysfunction (POCD) after coronary artery bypass grafting (CABG).Methods A total 106 patients with age ≥65 years and ASA Ⅱ~Ⅲ who were ready to receive CABG under general anaesthesia were enrolled in the study. The cognitive function of patients was assessed by means of Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at one day before surgery (T1),7 day (T1) after surgery and 30 days (T2) after surgery.According the the assessment results,these patients were divided into postoperative cognitive dysfunction (group P,n=21) and control group (n=85).The serum levels of S100β were measured by ELISA at 1day before surgery (T4),at the end of surgery (T5),1 day after surgery (T6) and 3 day after surgery (T7).Multivariate linear correlation analysis and Receiver operating characteristics (ROC) curve analysis were used to analyze the correlation between the S100β levels and perioperative variables as well as the optimum critical point in predicting the occurrence of POCD.Results The serum levels of S100βin group P were significantly higher than those in control group (P<0.01),and the length of staying in ICU and the postoperative length of staying in hospital in group P were significantly increased (P<0.01).The expression levels of S100β protein were positively correlated with the CPB time,aortic clump time and numbers of graft bridge,however,which were negatively correlated with MMSE scores and MoCA scores (P<0.01).The ROA curve analysis showed that optimum critical point of S100βin predicting the occurrence of POCD was 148.66pg/ml (area under the curve=0.793, 95% CI:0.698,P<0.01), with Max youden index being 0.46,sensitivity 81%,specificity 64.7%.Conclusion The expression levels of S100β protein in patients with POCD are significantly increased,and S100β levels>148.66pg/ml is a reliably prewarning factor in predicting the occurrence of POCD.

关 键 词：S100Β蛋白 术后认知功能障碍 体外循环 冠状动脉旁路移植术 老年 

分 类 号：R654.33[医药卫生—外科学]