冠心病患者PCI术后认知功能改变的相关研究

Changes of cognitive functions in patients with coronary heart disease after percutaneous coronary intervention:a correlation study

目的观察经皮冠状动脉介入治疗(PCI)和冠状动脉造影(CAG)对冠状动脉粥样硬化性心脏病(冠心病)患者围术期认知功能的影响,并探讨相应临床化验指标与认知功能障碍的相关性。方法连续收集于北京安贞医院心内科住院治疗的冠心病患者203例为研究对象,其中接受冠状动脉(冠脉)造影55例(CAG组),接受冠脉支架植入治疗148例(PCI组)。于术前及术后6 h,通过“基本认知能力测验”(BCAT)软件系统分别对两组患者术前及术后的加工速度、工作记忆及情景记忆进行检测,同时提取患者术前的相关实验室检查及手术相应临床指标。采用Wilcoxon符号秩检验比较患者的术前及术后认知功能评分的差异,采用皮尔逊相关系数评估各项实验室检查指标及临床指标与术后加工速度、工作记忆及情景记忆得分的相关性,采用多元线性回归评估各检查指标对于术后加工速度、工作记忆及情景记忆得分的影响。结果CAG组患者术前、术后各项认知功能评分均无显著性差异,而PCI组患者在加工速度、情景记忆两个维度上,术后的认知功能评分高于术前评分(P<0.05),在工作记忆维度上无显著性差异(P>0.05)。相关分析表明PCI组患者的年龄与术后工作记忆得分有显著负相关关系(r=-0.258,P<0.01),手术用时与术后情景记忆得分有显著负相关关系(r=-0.206,P<0.05),血清超敏C反应蛋白(hs-CRP)与术后加工速度得分有显著负相关关系(r=-0.273,P<0.01),血清同型半胱氨酸(Hcy)与术前和术后加工速度得分有显著负相关关系(r=-0.288,P<0.01),血清游离三碘甲状腺原氨酸(FT3)与术后情景记忆得分有显著正相关关系(r=0.296,P<0.01)。多元线性回归结果显示,年龄是PCI组患者术后工作记忆得分的独立危险因素(β=-0.238,P<0.05),hs-CRP和Hcy是PCI组患者术后加工速度得分的独立危险因素(β=-0.218~-0.207,P<0.05),FT3是PCI组患者术后情景记忆得分的独立保护因素(β=0.224,P<0.05)。结论冠心病患者接受PCI治疗可加重患者围术期认知功能障碍,应在术前注意筛查患者的认知功能状况并及时进行干预。年龄、手术时间、血清hs-CRP和Hcy水平的增高以及FT3水平的降低是PCI手术患者术后认知功能减低的重要影响因素,血清hs-CRP、Hcy及FT3水平对冠脉介入治疗术后认知功能障碍可能具有早期预测作用。

Objective To observe the influence of percutaneous coronary intervention(PCI)and coronary angiography(CAG)on perioperativecognitive function in patients with coronary heart disease(CHD),and discuss the correlation between clinical test indexes and cognitive impairment.Methods CHD patients(n=203)were continuously chosen from Department of Cardiology in Beijing Anzhen Hospital,and divided into CAG group(received CAG examination,n=55)and PCI group(received PCI,n=148).Before and 6 h after the operation,the processing speed,working memory and episodic memorywere detected by applying software system of basic cognitive ability test(BCAT),and at the same time,relevant laboratory examinations and operation-related clinical indexes were extracted in 2 groups.The differences in cognitive function scoreswere compared by using Wilcoxon signed-rank test between 2 groups before and after operation.The correlation among laboratory examination indexes,clinical indexes,and scores of postoperative processing speed,working memory and episodic memory were reviewed by using Pearson correlation coefficient.The influence of all examination indexes on scores of postoperative processing speed,working memory and episodic memory was reviewed by using multiple linear regression analysis.Results The scores of cognitive functions had no significant differences in CAG group before and after operation,and scores of processing speed and episodic memory were higher(P<0.05),and there was no significant difference in working memory(P>0.05)in PCI group than before.The results of correlation analysis showed that age was negatively correlated to scores of postoperative working memory(r=-0.258,P<0.01),and operation time negatively correlated toscoresof postoperative episodic memory(r=-0.206,P<0.05),high sensitivity C-reactive protein(hs-CRP)was negatively correlated to scores of postoperative processing speed(r=-0.273,P<0.01),and homocysteine(Hcy)was negatively correlated toscoresof preoperative and postoperative processing speeds(r=-0.288,P<0.01),and free triiodothyronine(fT3)was positively correlation to postoperative episodic memory(r=0.296,P<0.01)in PCI group.The results of multiple linear regression analysis showed that age was an independent risk factor for postoperative working memory(β=-0.238,P<0.05),hs-CRP and Hcy were independent factors for postoperative processing speed(β=-0.218--0.207,P<0.05),and fT3 was an independent protective factor for postoperative episodic memory(β=0.224,P<0.05)in PCI group.Conclusion The perioperative cognitiveimpairment will be aggravated in CHD patients received PCI,so the status of cognitive function should be screened and intervened before operation.Age,operation time,increased hs-CRP and Hcy levels,and decreased fT3 level are important influence factors for cognitiveimpairment after PCI.The levels of serum hs-CRP,Hcy and fT3 may have early predictive effects on cognitive impairment after PCI.