国际麻醉学与复苏杂志   2015, Issue (4): 5-5
    
老年全麻患者血清脂联素、基质金属蛋白酶?蛳9水平与术后认知功能障碍的关系
谢海辉, 黄德辉1()
1.广东省东莞市人民医院麻醉科
The relationship of serum levels of adiponectin, matrix metalloproteinase-9 and postoperative cognitive dysfunction in elderly patients after general anesthesia
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摘要:

目的 评价老年全身麻醉患者血清脂联素(adiponectin, ADP)及基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)水平与术后认知功能障碍(postoperation cognitive dysfunction, POCD)的关系。 方法 择期全身麻醉下行全髋关节置换术老年患者98例, 年龄65岁~83岁, 美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级, 性别不限。所有患者分别于手术前3 d及术后1、2、3、7 d采用蒙特利尔认知评估表(montreal cognitie assessment, MoCA)评估认知功能,并采集空腹静脉血标本测定血清ADP及MMP-9水平。根据术后3 d是否发生 POCD分为POCD组和无POCD组。 结果 28例患者发生POCD,发生率为28.5%, POCD组患者术后1、2、3 d及7 d血清MMP-9水平[(537±68)、(481±64)、(432±64)、(393±48) μg/L]较术前[(293±50) μg/L]明显升高(P<0.05), 血清ADP水平[(4.3±1.6)、(4.7±1.2)、(5.1±1.6)、(6.0±1.1) mg/L] 较术前[(9.39±1.36) mg/L]明显下降(P<0.05)。无POCD组术后1、2 d血清MMP-9水平较术前明显升高(P<0.05), 血清ADP水平较术前明显下降,术后3 d均恢复至术前水平。组间比较,POCD组术后各时间血清MMP-9水平明显高于无POCD组[(439±53)、(387±66)、(301±67)、(296±54) μg/L](P<0.05);而ADP水平均明显低于无POCD组[(5.7±1.0)、(6.7±1.4)、(9.1±1.0)、(9.4±1.2) mg/L] (P<0.05)。直线相关分析:POCD组患者血清MMP-9水平与 MoCA评分呈负相关(r=-0.833,P<0.01),ADP水平与 MoCA评分呈正相关(r=0.513,P<0.01)。 结论 老年全麻患者术后血清ADP水平下降与MMP-9水平升高可能参与了POCD发生的病理生理过程。

关键词: 术后认知功能障碍; 脂联素; 基质金属蛋白酶-9; 老年人; 麻醉,全身
Abstract:

Objective To evaluate the reIationship of the serum levels of adiponectin (ADP), matrix metalloproteinase-9(MMP-9) and postoperative cognitive dysfunction (POCD) in elderly patients after general anesthesia. Methods Ninety eight ASA Ⅰ or Ⅱ patients, aged 65 y-83 y, scheduled for artificial hip replacement under general anesthesia were studied. Cognitive functionwas assessed by Montreal Cognitie Assessment(MoCA), at 3 d before the operation and 1, 2, 3 d and 7 d after operation, and venous blood samples were collected for determination of serum ADP and MMP-9 levels at the same time in all patients. Patients were divided into POCD group and non-POCD group according to the occurrence of POCD in 3 d after operation. Results Twenty eight patients developed POCD(28.5%). Compared with the preoperative levels (293±50) μg/L, the serum levels of MMP-9 [(537±68),(481±64),(432±64),(393±48) μg/L] were significantly increased at 1, 2, 3 d and 7 d after operation, and the serum levels of ADP[(4.3±1.6),(4.7±1.2),(5.1±1.6),(6.0±1.1) mg/L] were significantly declined at 1, 2, 3 d and 7 d after operation compared with the preoperative levels(9.39±1.36) μg/L in group POCD(P<0.05). Compared with that of preoperation, the serum levels of MMP-9 were significantly increased, and the serum levels of ADP were significantly declined on 1,2 d in group non-POCD. The serum levels of MMP-9 in group POCD, were significantly higher than that in group non-POCD[(439±53),(387±66),(301±67),(297±54) μg/L](P<0.05) at 1,2,3,7 d after operation. Compared with group POCD, the serum levels of ADP [(5.7±1.0),(6.7±1.4),(9.1±1.0),(9.34±1.2) mg/L] were significanfly higher in group non-POCD(P<0.05) at 1,2,3,7 d after operation. Correlation analysis showed that the serum levels of MMP-9 were negatively correlated with MoCA score(r=-0.833,P<0.01), the serum 1evels of ADP were positively correlated with MoCA score(r=0.513,P<0.01). Conclusions An decreased postoperative serum ADP level and an increased postoperative serum MMP-9 level may be involved in the pathophysiological process of POCD in elderly patients with general anesthesia.

Key words: Postoperative cognitive dysfunction; Adiponectin; Matrix metalloproteinase-9; Aged; Anesthesia, general