外周血α1-抗糜蛋白酶的表达与术后认知功能障碍发生的关系  

Relationship between postoperative cognitive dysfunction and α1-antichymotrypsin level in plasma

作　　者：施丽燕[1] 徐静[1] 万燕杰[1] 

机构地区：[1]上海市浦东新区公利医院疼痛科,上海200135

出　　处：《上海医学》2014年第10期846-849,共4页Shanghai Medical Journal

基　　金：浦东新区卫生局卫生科技项目基金(PW2011A-9);浦东新区卫生系统优秀青年医学人才培养计划(PWRq-2012-16)资助项目

摘　　要：目的探讨术后认知功能障碍(POCD)与外周血α1-抗糜蛋白酶(ACT)的关系。方法选择于全身麻醉下行手术的患者60例,分别于术前1d和术后7d采用老年认知功能评价成套神经心理测验(BCAI)评估患者的认知功能,根据患者是否发生POCD分为POCD组(18例)和非POCD组(42例)。患者分别于术前、术毕和术后7d采血检测ACT水平。结果术后7d,POCD组的听觉词汇、分类、注销测验、语言能力、运动测验、视觉辨认、词汇回忆和空间结构得分均显著低于同组术前(P值均<0.05),数字连线得分显著高于同组术前(P<0.05);非POCD组的词汇回忆得分显著低于同组术前(P<0.05),数字连线得分显著高于同组术前(P<0.05)。POCD组在术前、术毕和术后7d的血浆ACT水平分别为(220.4±34.6)、(337.1±30.2)和(577.5±54.2)μg/mL,非POCD组分别为(238.8±20.8)、(296.4±38.1)和(438.3±40.1)μg/mL。两组间术前血浆ACT水平的差异无统计学意义(P>0.05),两组在术毕和术后7d的血浆ACT水平均显著高于同组术前(P值均<0.05),POCD组在术毕和术后7d的血浆ACT水平均显著高于非POCD组同时间(P值均<0.05)。结论 POCD的发生与外周血浆中ACT水平的升高有关。Objective To investigate the relationship between the expression of al-antichymotrypsin in plasma and postoperative cognitive dysfunction （POCD）. Methods Sixty patients undergoing operation under general anesthesia were enrolled in this study. The cognitive function of the patients was evaluated by a battery of cognitive assessment instruments （BCAI） 1 d preoperatively and 7 d postoperatively. The levels ofα1-antichymotrypsin were detected 1 d preoperatively, at the end of the surgery and 7 d postoperatively. Results The scores of auditory vocabulary, classification, cancellation test, language ability, exercise test, visual recognition, vocabulary memory and spatial structure 7 d postoperatively were significantly lower than preoperative ones in the patients with POCD （all P〈0.05）, while the score of digital connection 7 d postoperatively was significantly higher than the preoperative one （P 〈 0.05）. The score of vocabulary memory 7 d postoperatively was significantly lower than the preoperative one in the patients without POCD （P〈0.05）, while the score of digital connection 7 d postoperatively was significantly higher than the preoperative one （P〈0.05）. The level of al-antichymotrypsin were （220.4 ±34.6）, （337. 1 ±30.2） and （577.5 ±54.2） μg/mL in the POCD patients before surgery, at the end of surgery and 7 d after surgery, respectively; in the non-cognitive dysfunction patients, the levels of al-antichymotrypsin were （238. 8 ± 20. 8）, （296. 4 ±38. 1） and （438. 3 ±40. 1） μg/mL, respectively. There was no significant difference in the level of α1-antichymotrypsin between the patients with and without POCD （P〈 0. 05）, Compared to preoperative ones, the expression of α1-antichymotrypsin weresignificantly increased in all patients at the end of surgery and 7 d after surgery （all P〉0.05）. The levels of α1- antichymotrypsin in POCD patients were significantly higher than those in non-cognitive dysfunction patients at the end of surgery a

关 键 词：术后认知功能障碍 Β-淀粉样蛋白 Α1-抗糜蛋白酶 

分 类 号：R614[医药卫生—麻醉学]