老年患者全髋关节置换术后早期认知功能障碍与炎症关系的研究  

Association between inflammation and postoperative cognitive dysfunction in elderly patients undergoing total hip-replacement surgery

作　　者：李航[1] 吕蕾[1] 邵军进[1] 

机构地区：[1]温州医科大学附属东阳医院麻醉科,322100

出　　处：《浙江医学》2015年第10期854-857,共4页Zhejiang Medical Journal

摘　　要：目的探讨老年患者全髋关节置换术后早期认知功能障碍(POCD)的发生机制。方法选择接受择期单侧全髋关节置换术的老年患者38例,应用简易精神状态量表(MMSE)对患者的认知功能进行评定,根据是否发生POCD分为POCD组17例和非POCD组21例,检测并比较术前及术后1d外周血IL-6、TNF-α和外周血CD4^+CD25^+CD127^(low/-)T细胞的水平。结果 POCD组及非POCD组术后1d的TNF-α及IL-6水平均高于术前,差异均有统计学意义(均P<0.05);POCD组术后TNF-α及IL-6水平均明显高于非POCD组,差异有统计学意义(P<0.05);POCD组术后外周血CD4^+CD25^+CD127^(low/-)T细胞比率明显低于术前,差异有统计学意义(P<0.05)。非POCD组术后外周血CD4^+CD25^+CD127^(low/-)T细胞比率与术前比较无统计学差异(P>0.05)。POCD组术后外周血CD4^+CD25^+CD127^(low/-)T细胞比率明显低于非POCD组,差异有统计学意义(P<0.05)。结论老年患者全髋关节置换术后早期POCD的发生可能与炎性反应及外周血调节性T细胞数量减少有关。Objective To investigate the association between inflammation and postoperative cognitive dysfunction （POCD） in elderly patients undergoing total hip-replacement surgery. Methods Thirty eight elderly patients undergoing selective hip-replacement surgery were enrolled in the study. Neuropsychological test was performed with Mini-mental State Examination （MMSE） before and dl after surgery, the patients were classified as POCD group（n=17） and non-POCD group （n=21） according to MMSE results, Tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6） and the blood regulatory T cells （CD4^＋CD25^＋CD127^low/-） were measured before operation and dl after operation. Results Compared to preoperative levels, serum TNF-α and IL-6 levels were significantly increased after surgery in both groups （P〈0.05）; the postoperative TNF-α and IL-6 levels in POCD group were significantly higher than those in non-POCD group （P〈0.05）. The postoperative blood contents ofCD4^＋CD25^＋CD127^low/- cells in POCD group were significantly lower than preoperative levels （2.31 ±0.82% vs 4.93 ±1.11%, P〈0.05）, while there was no significant difference before and after operation in non-POCD group （4.89 ±1.14%vs 5.05 ±1.31 %, P 〉0.05）. The blood contents of CD4^＋CD25^＋CD127^low/- cells in POCD group were significantly lower than those in non-POCD group （2.31 ±0.82%vs 4.89 ±1.14%, P〈0.05）. Conclusion Early postoperative inflammation response and the reduction in regulatory T cells may be associated with the development of POCD in elderly patients undergoing total hip-replacement.

关 键 词：术后认知功能障碍 炎性反应 调节性T细胞 

分 类 号：R687.4[医药卫生—骨科学]