脑脊液胆碱乙酰转移酶及胆碱酯酶与老年患者术后谵妄的关系  

Relationship of cerebrospinal fluid choline acetyltransferase and cholinesterase withpostoperative delirium in elderly patients

作　　者：刘晨 李肖璇 毕燕琳[3] 林旭[3] 王彬[3] 齐峰[1] LIU Chen;LI Xiaoxuan;BI Yanlin;LIN Xu;WANG Bin;QI Feng(Department of Anesthesiology,Qilu Hospital of Shandong University,Jinan,Shandong 250012,China)

机构地区：[1]山东大学齐鲁医院麻醉科,山东济南250012 [2]青岛市妇女儿童医院麻醉科,山东青岛266000 [3]青岛市市立医院麻醉科,山东青岛266000

出　　处：《中国临床研究》2024年第4期510-513,共4页Chinese Journal of Clinical Research

摘　　要：目的 检测老年患者脑脊液胆碱乙酰转移酶(ChAT)及胆碱酯酶(ChE)浓度,探讨其与术后谵妄(POD)的关系。方法 纳入2018年9月至2019年8月于青岛市市立医院行全膝/全髋关节置换术的患者183例。全部患者实施全膝或全髋关节置换术,采用腰硬联合麻醉,在蛛网膜下腔穿刺完毕之后,提取脑脊液2 mL。使用酶联免疫吸附试验法检测脑脊液ChAT、ChE、肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)的浓度;使用分光光度法检测脑脊液ChAT、ChE的活性。手术后采用意识模糊评估法(CAM)评定POD的发生情况。结果 术后72 h内183例患者,未发生POD 157例(非POD组),发生POD 26例(POD组),发生率为14.21%。与非POD组相比,POD组术前脑脊液ChE浓度[(31.99±2.78)vs(40.89±4.19) ng/mL,t=13.915,P<0.01]明显降低,ChAT[(1.26±0.12)vs(0.86±0.15) ng/mL,t=12.920,P<0.01]、TNF-α [(17.19±1.32)vs(12.29±1.64) pg/mL,t=14.467,P<0.01]、IL-6 [(33.98±5.02)vs(16.98±3.41) pg/mL,t=16.643,P<0.01]浓度明显升高。与非POD组相比,POD组术前脑脊液ChE活性明显降低[(4.28±0.52)vs(5.25±0.26) u/mL,t=9.321,P<0.01],ChAT活性明显升高[(0.36±0.05)vs(0.27±0.03) u/mL,t=8.916,P<0.01]。结论 脑脊液中的ChAT高活性、ChE低活性与老年患者POD的发生有关,其中胆碱能的退化与其发生密切相关。Objective To detect the concentrations of choline acetyltransferase(ChAT)and cholinesterase(ChE)in cerebrospinal fluid of elderly patients and explore their relationship with postoperative delirium(POD).Methods One hundred and eighty-three patients who underwent total knee/total hip arthroplasty at Qingdao Municipal Hospital from September 2018 to August 2019 were included.All patients underwent total knee or total hip arthroplasty,using combined spinal-epidural anesthesia.After subarachnoid puncture,2 mL of cerebrospinal fluid(CSF)was extracted.Enzyme-linked immunosorbent assay was used to detect the concentration of ChAT,ChE,tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in CSF,and spectrophotometry was used to detect the activity of ChAT and ChE in CSF.The occurrence of POD was assessed using the Confusion Assessment of Method(CAM)after surgery.Results Among 183 patients,157 cases without POD were as non-POD group and 26 cases with POD were as POD group,with an incidence rate of 14.21%.In the POD group,the preoperative CSF ChE concentration[(31.99±2.78)vs(40.89±4.19)ng/mL,t=13.915,P<0.01]significantly reduced,while ChAT[(1.26±0.12)vs(0.86±0.15)ng/mL,t=12.920,P<0.01],TNF-α[(17.19±1.32)vs(12.29±1.64)pg/mL,t=14.467,P<0.01],and IL-6[(33.98±5.02)vs(16.98±3.41)pg/mL,t=16.643,P<0.01]significantly increased compared to the non-POD group.In the POD group,the preoperative CSF ChE activity significantly reduced[(4.28±0.52)vs(5.25±0.26)u/mL,t=9.321,P<0.01],while ChAT activity significantly increased[(0.36±0.05)vs(0.27±0.03)u/mL,t=8.916,P<0.01]compared to the non-POD group.Conclusion The high activity of ChAT and low activity of ChE in CSF are related to the occurrence of POD in elderly patients,with cholinergic degradation closely related to its occurrence.

关 键 词：脑脊液 胆碱酯酶 胆碱乙酰转移酶 术后谵妄 老年 关节置换术 

分 类 号：R614[医药卫生—麻醉学]