胸腹主动脉夹层手术脊髓损伤标记物临床研究

Clinic Research of Biomarkers for Spinal Cord Ischemic Injury during Thoracoabdominal Aortic Dissection Operation

目的探讨脑脊液生化指标监测对胸腹主动脉夹层术后脊髓缺血损害判断的临床意义。方法将50例胸腹主动脉夹层手术患者根据术后是否发生脊髓缺血损害并发症分成损伤组(SCI组,n=5)和无损伤组(NSCI组,n=45)。术前、术后分7个时点对脑脊液取样,对胶质纤维酸蛋白(GFAP)、S100β蛋白以及神经丝蛋白亚单位(NFL)等3个生化指标进行测定。比较分析上述3个生化指标在2组之间的变化。将无脊髓损伤患者据术式分为血管置换手术组(AR组,n=9)和腔内隔绝术组(EVGE组,n=36),同样比较分析上述3个生化指标在2组之间的差异。结果 SCI组术后6 h各项生化指标开始升高,48-72 h各项指标明显高于NSCI组(P<0.01)。术后6 h以后GFAP、S100β蛋白测定数值在2组之间数值无重叠。腔内隔绝术后各项指标无明显升高,血管置换术后6 h起GFAP、S100β开始升高,术后24 h达到峰值,较术前相比差异有统计学意义(P<0.05),同时高于腔内隔绝术后对应时点。血管置换术后(第24h4、8 h)时点NFL高于腔内隔绝术后对应时点(P<0.05)。结论脑脊液生化指标持续监测可以预判迟发性脊髓损害。GFAP、S100β蛋白比NFL诊断脊髓损伤有更高的预测价值。

Objective To investigate the predictive value of biochemical markers in cerebrospinal fluid（CSF） to the diagnosis of spinal cord ischemic injury after thoracoabdominal aortic dissection（AD） repair operation.Methods 50 patients underwent AD operations were divided into spinal cord ischemia（SCI） group（n=5） and no spinal cord ischemia（NSCI） group（n=45）.CSF concentrations of the biomarkers glial fibrillary acidic protein（GFAP）,S100βprotein and the light subunit of neurofilament triplet protein（NFL） were determined respectively at 7 different timepoints during perioperative period.The levels of biomarkers were compared between two groups.NSCI patients were divided subsequently into two groups,aorta replacement（AR） group（n=9）and endovascular graft exclusion（EVGE） group（n=36）.The levels of biomarkers were also compared between two groups.Results The concentration of biomarkers increased from 6 hours postoperativly in SCI group.The biomarker levels at 48-72 hour postoperativly were significantly higher in SCI group compared with those in NSCI group（P0.01）.The concentration of GFAP and S100β6 hours after surgery were totally separated from that of NSCI group.No obvious elevation of biomarkers was observed in EVGE group.The concentration of GFAP and S100βprotein increased from 6 hours postoperativly in AR group and achieved peak value at 24 hours.The increase of GFAP and S100βprotein were apparent compared with preoperative status（P0.05） and were also obvious compared with EVGE group（P0.05）.The NFL levels of AR group at 24-48 hour postoperativly were significantly higher than that of EVGE group（P0.05）.Conclusion Biochemical markers in cerebrospinal fluid（CSF） are valuable to the postoperative monitoring of spinal cord ischemia after thoracoabdominal aortic dissection（AD） repair operation.GFAP and S100β protein in CSF are more valuable than NFL for predicting postoperative spinal cord ischemia.