| 张 斌,刘春意,仝昊坤,仝 坤,王巧妍.心脏术后认知障碍患者血清NFL、S100β及CRP水平变化及其与预后的相关性[J].,2025,(18):2941-2948 |
| 心脏术后认知障碍患者血清NFL、S100β及CRP水平变化及其与预后的相关性 |
| Changes in Serum NFL, S100 β, and CRP Levels in Patients with Cognitive Impairment after Cardiac Surgery and Their Correlation with Prognosis |
| 投稿时间：2025-05-15 |
| DOI：10.13241/j.cnki.pmb.2025.18.009 |
| 中文关键词: 神经丝轻链 结合蛋白S100β C反应蛋白 心脏手术 认知障碍 影响因素 预后 |
| 英文关键词: Neurofilament light chain Binding protein S100 β C-reactive protein Heart surgery Cognitive impairment Influencing factors Prognosis |
| 基金项目:江苏省重点实验室开放课题（XZSYSKF2023029(K.T.)） |
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| 中文摘要: |
| 摘要 目的：分析心脏术后认知障碍患者血清神经丝轻链（NFL）、结合蛋白S100β（S100β）及C反应蛋白（CRP）水平变化，并分析上述指标与患者预后的相关性。方法：选取于2022年1月至2025年1月收治的124例心脏疾病手术治疗患者，术后1周对患者采用蒙特利尔认知评估量表（MoCA）展开评价，将MoCA评分＜26分的60例患者分为认知障碍组，将≥26分的64例患者分为非认知障碍组。比较两组一般资料，手术前后血清NFL、S100β及CRP水平变化。采用Logistic回归法分析心脏术后认知障碍发生的影响因素。随后对认知障碍组患者进行4个月术后随访，评估其MoCA分数，将MoCA＜26分患者分为预后不良组，将其余患者分为预后良好组，对比两组NfL、 S100β及CRP水平，采用受试者工作特征（ROC）曲线分析血清NFL、 S100β及CRP对心脏术后认知障碍患者预后不良的预测价值。结果：认知障碍组、非认知障碍组性别、BMI、受教育水平、合并基础疾病（高血压、糖尿病）、疾病类型、ASA分级、术中出血量、术中补液量、体外循环时间比较无明显差异（P＞0.05），认知障碍组年龄、术中麻醉维持时间、术后无镇痛及苏醒期躁动发生率均高于非认知障碍组（P＜0.05）；术前两组患者血清NFL、S100β及CRP水平比较无明显差异（P＞0.05），术后3 d两组血清NFL、S100β及CRP水平均升高，认知障碍组高于非认知障碍组（P＜0.05）；Logistic回归分析结果显示，年龄、术中麻醉维持时间、苏醒期躁动、术后3 d NFL、S100β、CRP为心脏术后认知障碍的独立影响因素（P＜0.05）；术后3 d预后良好组、预后不良组血清NFL、S100β及CRP水平均高于术前，且预后不良组术前、术后3 d NFL、S100β及CRP水平均高于预后良好组（P＜0.05）；以预后不良作为阳性样本，预后良好为阴性样本，绘制ROC曲线，结果显示，手术前后3指标联合预测心脏术后认知障碍预后不良的灵敏度与特异度高于单一指标（P＜0.05）。结论：心脏术后认知障碍患者血清NFL、S100β及CRP水平明显升高，且术后早期NFL、S100β及CRP升高为认知障碍发生的影响因素，通过术前及术后早期检测上述指标可预测心脏术后认知障碍患者预后情况。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the changes in serum levels of neurofilament light chain (NFL), binding protein S100 β (S100 β), and C-reactive protein (CRP) in patients with cognitive impairment after cardiac surgery, and to analyze the correlation between these indicators and patient prognosis. Methods: 124 patients with heart disease who underwent surgical treatment from January 2022 to January 2025 were selected. One week after surgery, the patients were evaluated using the Montreal Cognitive Assessment Scale (MoCA). 60 patients with MoCA scores < 26 were divided into the cognitive impairment group, and 64 patients with MoCA scores ≥ 26 were divided into the non cognitive impairment group. Compare the general information of two groups, including changes in serum NFL, S100 β, and CRP levels before and after surgery. Using logistic regression to analyze the influencing factors of cognitive impairment after cardiac surgery. Following a 4-month postoperative follow-up, the cognitive impairment group was assessed using the MoCA score. Patients with a MoCA score < 26 were categorized as having a poor prognosis, while the remaining patients were classified as having a good prognosis. The NfL, S100β, and CRP levels in both groups were compared, and the ROC curve was used to evaluate the predictive value of serum NFL, S100β, and CRP for poor prognosis in patients with postoperative cognitive impairment. Results: There was no significant difference in gender, BMI, education level, comorbidities (hypertension, diabetes), disease type, ASA classification, intraoperative blood loss, intraoperative fluid replacement, and cardiopulmonary bypass time between cognitive impairment group and non-cognitive impairment group (P>0.05). The cognitive impairment group had a higher incidence of age, anesthesia maintenance time during surgery, no analgesia after operation and agitation during awakening than the non-cognitive impairment group (P<0.05); There was no significant difference in the levels of serum NFL, S100 β, and CRP between the two groups of patients before surgery (P>0.05). On postoperative day 3, the levels of serum NFL, S100 β, and CRP increased in both groups, with the cognitive impairment group being higher than the non cognitive impairment group (P<0.05); Using cognitive impairment (occurrence=1, no occurrence=0) as the dependent variable, logistic regression analysis showed that age, intraoperative anesthesia maintenance time, agitation during the recovery period, postoperative 3-day NFL, S100 β, CRP were independent influencing factors of cognitive impairment after cardiac surgery (P<0.05); The serum levels of NFL, S100 β, and CRP in the good prognosis group and poor prognosis group were higher than those before surgery, and the NFL, S100 β, and CRP levels in the poor prognosis group were higher than those in the good prognosis group before and after surgery (P<0.05); Using poor prognosis as positive samples and good prognosis as negative samples, a ROC curve was plotted. The results showed that the sensitivity and specificity of the combined prediction of three indicators before and after surgery for poor prognosis of cognitive impairment in cardiac surgery were higher than those of a single indicator (P<0.05). Conclusion: The serum levels of NFL, S100 β, and CRP are significantly elevated in patients with cognitive impairment after cardiac surgery, and the early postoperative elevation of NFL, S100 β, and CRP is a contributing factor to the occurrence of cognitive impairment. Preoperative and early postoperative detection of these indicators can predict the prognosis of patients with cognitive impairment after cardiac surgery. |
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