髓样细胞触发受体与老年患者术后认知功能障碍的关系  

Relationship between triggering receptor expressed on myeloid cells and postoperative cognitive dysfunction in elderly patients

作　　者：张金玲 王彬[1] 孙晓鹏[1] 王明山[1] 徐晓娜[2] 毕燕琳[1] Zhang Jinling;Wang Bin;Sun Xiaopeng;Wang Mingshan;Xu Xiaona;Bi Yanlin(Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao Univesity, Qingdao 266071,China;Department of Central Laboratory, Qingdao Municipal Hospital, Qingdao Univesity, Qingdao 266071,China)

机构地区：[1]青岛大学附属青岛市市立医院麻醉科,266071 [2]青岛大学附属青岛市市立医院中心实验室,266071

出　　处：《中华麻醉学杂志》2018年第12期1421-1425,共5页Chinese Journal of Anesthesiology

基　　金：青岛市市南区科技局立项课题(2014-14-032-YY).

摘　　要：目的评价髓样细胞触发受体(TREM)与老年患者术后认知功能障碍(POCD)的关系。方法择期脊椎-硬膜外联合阻滞下行全膝关节置换术的患者80例,年龄65~85岁,体重50~80kg,ASA分级Ⅰ-Ⅲ级。蛛网膜下腔穿刺成功后抽取脑脊液,于麻醉前(T0)、术后24h(T1)、术后72h(T2)时取肘静脉血样,采用ELISA法检测脑脊液和血浆TREM1、TREM2浓度,血浆IL-6和TNF-α浓度,采用RT-PCR法测外周血单核细胞TREM1、TREM2、IL-6以及TNF-α的mRNA表达。于术前1d、术后7d同一时段进行神经心理学测试,采用Z计分法判断POCD的发生情况。术后根据是否发生POCD分为POCD组(P组)和非POCD组(NP组)。结果POCD发生率为22%。与NP组相比,P组T1,2时血浆TREM1、T2时血浆IL-6和TNF-α浓度升高,T1,2时TREM1mRNA和TNF-αmRNA表达上调,T2时IL-6mRNA表达上调(P<0.05)。血浆TREM2浓度组间和组内比较差异无统计学意义(P>0.05);血浆与脑脊液TREM1浓度一致性较高(Cronbach′sAlpha=0.784,P<0.01);血浆与脑脊液TREM2浓度具有高度一致性(Cronbach′sAlpha=0.935,P<0.01)。结论外周和中枢TREM1表达上调与老年患者POCD的发生有关。Objective To evaluate the relationship between the triggering receptor expressed on myeloid cells (TREM) and postoperative cognitive dysfunction (POCD) in elderly patients. Methods Eighty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients, aged 65-85 yr, weighing 50-80 kg, scheduled for elective total knee replacement under spinal-epidural anesthesia were enrolled in this study.Cerebrospinal fluid (CSF) was extracted after a catheter was successfully inserted into subarachnoid space.Blood samples from the cubital vein was collected before anesthesia induction (T0) and at 24 and 72 h after surgery (T1, 2). The concentrations of TREM1 and TREM2 in CSF and plasma and tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in plasma were measured by enzyme-linked immunosorbent assay.The expression of TREM1, TREM2, IL-6 and TNF-α protein and mRNA in mononuclear cells in peripheral blood was detected using real-time polymerase chain reaction.Neuropsychological test was performed in the the same time period at 1 day before surgery and 7 days after surgery, and the Z score was used to diagnose the development of POCD.The patients were divided into POCD group (P group) and non-POCD group (NP group) according to whether or not POCD happened after surgery. Results The incidence of POCD was 22%.Compared with group NP, the plasma TREM1 concentrations at T1, 2 and plasma IL-6 and TNF-α concentrations at T2 were significantly increased, and the expression of TREM1 mRNA and TNF-α mRNA at T1, 2 and IL-6 mRNA at T2 was up-regulated in group P (P<0.05). There was no significant difference in plasma TREM2 concentrations at each time point between and within groups (P>0.05). There was a higher consistency between plasma and CSF TREM1 concentrations (Cronbach′s Alpha=0.784, P<0.01) and a high consistency between plasma and CSF TREM2 (Cronbach′s Alpha=0.935, P<0.01). Conclusion Up-regulated expression of central and peripheral TREM1 is related to the development of POCD in elderly patients.

关 键 词：老年人 认知障碍 髓系细胞 受体 免疫 

分 类 号：R614[医药卫生—麻醉学]