The Analysis Of The Risk Factors Of Depression And Or Postoperative Cognitive Dysfunction In Patients Undergoing Revascularization Therapy Methods And Related Chemical Markers

Objective1.This study was to survey the incidence of postoperative cognitive dysfunction and depression in patients undergoing coronary artery bypass graft, and using Logistic multivariate regression analysis to analyse its associated risk factors,in order to explore independent predictors.2. This study was to survey the incidence of postoperative depression in patients undergoing percutaneous coronary intervention, and using Logistic multivariate regression analysis to analyse its associated risk factors,in order to explore independent predictors.3.To compare the incidence of depression beween CABG and PCI.4.To investigate the impact of depression on clinical outcome of patients undergoing revascularization and the related chemical markers.Methods1.The study enrolled258consecutive patients admitted to chest hospital from April2012to February2013, deciding to undergo coronary artery bypass grafting (CABG) surgery, and divided into the cardiopulmonary bypass groups (n=153, group I) and off-pump coronary artery bypass graft group (n=105, group Ⅱ) randomly. Right internal jugular vein was punctured and the catheter was advanced regressively up to the bulb of internal jugular vein after anesthesia induction.The blood sample of internal jugular vein were taken for determination of serum S-100protein and neuron specific enolization enzyme (NSE) content at the moment after anesthesia induction (baseline value, TO), the process of operation (Tl), the end of operation(T2),6h after operation (T3) and24h after operation (T4). A mini-mental state examination (MMSE) was performed1day before and3,7days after operation respectively, using ZUNG self-rating depression scale (SDS) to score1day before and7day after operation. The total scores of MMSE was30points, those scores not reach24points were defined as postoperative cognitive dysfunction (POCD). The total scores of SDS was100points, the Chinese norm:53points was boundary value, less than52points defined as normal; between53and62points defined as mild depression; between63and72points defined as moderate depression; more than73points defined as severe depression. According to the result of evaluation patients were divided into depression group and non-depression group. Recording clinical characteristics, past history, the treatment time in intensive care unit, endotracheal intubation time, postoperative hospitalization days, etc. All the patients were followed for1year after operation for the occurrence of major adverse cardiovascular events (MACE), including for all-cause mortality, nonfatal myocardial infarction or target lesion reconstruction (TLR). Then,making K-M survival curve analysis after follow-up.2.The study enrolled235consecutive patients admitted to chest hospital from April2012to February2013, deciding to undergo percutaneous coronary intervention (PCI), using ZUNG self-rating depression scale (SDS) to score1day before and7day after operation. The total scores of SDS was100points, the Chinese norm:53points was boundary value, less than52points defined as normal; between53and62points defined as mild depression; between63and72points defined as moderate depression; more than73points defined as severe depression. According to the result of evaluation patients were divided into depression group and non-depression group. Recording clinical characteristics, the biochemical indexes, echocardiogram results, etc. All the patients were followed for1year after operation for the occurrence of major adverse cardiovascular events (MACE), including for all-cause mortality, nonfatal myocardial infarction or target lesion reconstruction (TLR).Then,making K-M survival curve analysis after follow-up.3.Research Object:part one CABG and part two PCI patients4.ZUNG self-rating depression scale (SDS):as previous standard5.determine the serum level of interleukin6(IL-6)Results120cases were postoperative cognitive dysfunction (13.1%)in I group,35cases (33.3%)in II group, the difference was statistically significant (P<0.001).2The contents of serum S-100protein and NSE increased at Ti(P<0.05),reached peak at T2(P<0.05),then decreased at T3in both groups(P<0.05).The contents of serum S-100protein and NSE returned to baseline level at T4in group I(P>0.05),while in group Ⅱ,the contents of serum S-100protein and NSE were higher than baseline level at T4(P<0.05).The contents of serum S-100protein and NSE were higher in group Ⅱ than those in groupⅠat Ti-T4(P<0.05).3The preoperative and postoperative incidence of depression have no statistical significance between group Ⅰ and group Ⅱ (P=0.959; P=0.703), compared with the preoperative, postoperative incidence increased significantly (P=0.003), severe depression were30cases (11.6%)among them increased significantly (P=0.031). Mild-to-moderate depression were62cases (24.0%)increase significantly (P=0.041) compared with preoperative.4Multivariable logistic regression analysis showed that, female (OR4.11, CI(1.28—13.18), P=0.018)、history of alcoholism (OR3.98, CI (1.18—13.36), P=0.026)、operation method (CPB)(OR22.30, CI(5.54—89.88), P<0.001)、preoperative depression (OR20.04, CI(4.52—88.94), P<0.001) and intraoperative hypotension (OR20.76, CI(4.84—89.02), P<0.001) were CABG independent risk factors of postoperative cognitive dysfunction; female (OR2.74, CI (1.31—5.71),P=0.007)and preoperative depression (OR26.60,CI(8.89—79.62), P<0.001) were independent risk factors of depression with CABG.5There were12cases (13.0%) occurred MACE in patients with depression within1year after discharge, significantly higher than the depression group patients (6cases,3.6%, P=0.004). COX multiple factors regression analysis showed that depression was independent risk factors for postoperative patients occurred MACE with CABG (HR5.24, CI,1.7116.04), P=0.004).6Preoperative and postoperative patients with depression were29cases (12.3%),54cases (23.0%) respectively, postoperative incidence of depression significantly higher compared with preoperative (P=0.002).7Multivariable logistic regression analysis showed that,female(OR2.50, CI(1.26-4.97), P=0.009), history of myocardial infarction (OR2.39, CI(1.18-4.85), P=0.016) and intervention treatment time (OR17.11, CI (1.78-164.30), P=0.014) were independent risk factors for postoperative depression with PCI.8There were7cases (13.0%) occurred MACE in patients with depression within1year after discharge, significantly higher than non-depression group patients (3cases,1.7%, P=0.002). COX multiple factors regression analysis showed that depression (HR5.40, CI (1.14-25.65), P=0.034) and history of diabetes (HR6.90, CI (1.17-40.79), P=0.033) were independent risk factors for postoperative patients occurred MACE with PCI.9The incidence of depression with CABG patients was significantly higher than with PCI patients (35.6%vs23.0%, P=0.002).The difference of incidence of depression between CABG in patients with mild depression and PCI patients was statistically significant (22.1%vs12.3%, P=0.004), The incidence of severe depression with CABG was a little higher than in patients with PCI, but there was no statistically significant difference (11.6%vs7.7%, P=0.138). In addition, the incidence of moderate depression in patients with PCI was higher than with CABG, but there was no significant difference (3.0%vs1.9%, P=0.454).The grafts in CABG group is (3.1±0.6), stents in PCI group is(1.8±0.7), syntax score in CABG group is higher than PCI group (34.7±7.1vs24.5±5.0, P<0.001)10Compare preoperative SDS score of PCI treatment group with CABG group,there was no statistically significant difference (37.42±11.77vs44.23±13.45, P=0.982). Postoperative SDS score with CABG was significantly higher than with PCI (44.23±13.45vs47.07±14.10, P=0.023)11PCI treatment group:the level of serum IL-6of moderate and severe depression group were significantly higher than mild depression group (P=0.037; P=0.003), but there was no significant difference between moderate depression group and severe depression group[(102.7±21.81) pg/ml vs (102.9±15.22) pg/ml, P=0.981]Conclusion1Off-pump CABG could decrease the incidence of postoperative cognitive dysfunction(POCD)through compare with traditional on-pump CABG.2S-100protein and NSE as an early diagnosis of serum markers for POCD have high sensitivity and specificity.3Higher proportion of patients after CABG were different levels of depression.4Female、history of alcoholism、operation method (CPB)、preoperative depression and intraoperative hypotension were CABG independent risk factors of postoperative cognitive dysfunction; female and preoperative depression were CABG independent risk factors of depression.5Patients with depression after operation is related to recurrent ischemic events, was independent risk factors for postoperative patients occurred MACE.6Higher proportion of patients after PCI were different levels of depression.7Female, history of myocardial infarction and intervention treatment time were independent risk factors for postoperative depression with PCI.8Depression and history of diabetes were independent risk factors for postoperative patients occurred MACE with PCI.9Higher proportion of patients after revascularization were different levels of depression.Compared with PCI,CABG as a bigger risk of trauma surgery had greater influence on postoperative patients with depression.lOSerum IL-6as a kind of cytokines in inflammatory response, it plays an important role in predicting the incidence of depression in patients combined with coronary heart disease.