Study On The Association Of Serum Neuropeptides Concentration And Intraoperative Adverse Cardiovascular Events In Diabetic Patients

Objective:To investigate the association of perioperative changes in serum neuropeptides Y,substance P,calcitonin gene-related peptide,cardiac troponin I and intraoperative adverse cardiovascular events in diabetic patients.Methods:The patients（n=104）undergoing elective lower extremity operation under subarachnoid anesthesia were enrolled and assigned to diabetic group（DM）and non-diabetic group（NDM）,according to whether they were complicated with type 2diabetes before operation.Each of the groups were further divided into two subgroups,diabetes with cardiovascular disease,as DM-CVD（n=22）,diabetes without cardiovascular disease,as DM-NCVD（n=20）,non-diabetic patients with cardiovascular disease,as NDM-CVD（n=35）,and non-diabetic without cardiovascular disease,NDM-NCVD（n=27）,according to whether or not the patients were complicated with cardiovascular disease before operation.The preoperative general characteristics,gender,age,ASA grade,body mass index,blood lipid,glycosylated hemoglobin,preoperative and postoperative blood glucose,intraoperative vital signs,operating time,anesthetic time,infusion volume were recorded.The blood samples（5mL）were collected from non-infused cubital vein at 30 minutes before operation（T₀）and 24 hours after operation（T₁）respectively.The serum concentration of NPY,SP,CGRP and cTnI were measured by ELISA method.Results:1.The incidence of ACVE in DM group was higher than that in NDM group（P<0.05）.2.Serum SP,CGRP in DM group before and 24 hours after operation were lower than those in NDM group SP,CGRP（P<0.05）,and Serum cTnI in DM group was higher than that in NDM group（P<0.05）,but there was no difference in serum NPY concentration.NPY in DM-CVD group before operation was higher than NPY in NDM-CVD group（P<0.05）,and CGRP in DM-CVD group before operation was lower than that in NDM-CVD group（P<0.05）,but there was no difference in serum SP and cTnI levels.SP,CGRP in DM-NCVD group before and 24 hours after operation were lower than those in NDM-NCVD group SP,CGRP（P<0.05）,and cTnI in DM-NCVD group 24hours after operation was higher than those in NDM-NCVD group（P<0.05）,but there was no difference in serum NPY concentration.In the DM group,Compared with NPY and cTnI of before operation,NPY and cTnI of 24 hours after operation increased（P<0.05）.Compared with SP of before operation,SP of 24 hours after operation decreased（P<0.05）.But there was no difference in serum CGRP concentration.In the NDM group,Compared with NPY of before operation,NPY of 24hours after operation increased（P<0.05）.Compared with SP、CGRP of before operation,SP、CGRP of 24 hours after operation decreased（P<0.05）.But there was no difference in serum cTnI concentration.3.Compared with NACVE group,preoperative diabetes mellitus in ACVE group increased the incidence of ACVE（P<0.05）,but there was no difference in preoperative cardiovascular disease.The preoperative SP in ACVE group was lower than that in NACVE group（P<0.05）,but the serum levels of NPY,CGRP and cTnI had no difference.In the DM-CVD and NDM-CVD groups,the preoperative NPY in ACVE group was higher than that in NACVE group（P<0.05）,but there was no difference in serum SP,CGRP and cTnI levels.In DM-NCVD and NDM-NCVD groups,preoperative SP in ACVE group was lower than that in NACVE group（P<0.05）,and preoperative cTnI in ACVE group was higher than that in NACVE group（P<0.05）,but there was no difference in serum NPY and CGRP levels.In ACVE group,compared with NPY before operation,NPY of 24 hours after operation increased（P<0.05）.Compared with SP before operation,SP of 24 hours after operation decreased（P<0.05）.But there was no difference in serum CGRP and cTnI levels.In NACVE group,Compared with NPY before operation,NPY of 24 hours after operation increased（P<0.05）.Compared with SP before operation,SP of 24 hours after operation decreased（P<0.05）.But there was no difference in serum CGRP and cTnI levels.4.Logistic regression analysis was made on the statistical factors between DM group and NDM group,preoperative diabetes mellitus and preoperative NPY/SP were the risk factors for ACVE（P<0.05）.5.Compared with CVD group,NPY of 24 hours after operation was higher than that in NCVD group（P<0.05）.But there was no difference in serum SP,CGRP and cTnI levels.Conclusion:The morbidity of intraoperative cardiovascular events is associated with the increase in serum concentrations of NPY and decrease in serum concentrations of SP in diabetic patients.The progression of cardiovascular disease may be related to the elevation of serum NPY.