摘要
目的分析全麻髋关节置换术后老年患者认知功能障碍(postoperative cognitive dysfunction,POCD)同围手术期外周血辅助性T细胞(T helper,Th)17和其效应因子的相关性。方法选取2018年1月至2020年1月在菏泽市立医院行全麻下髋关节置换术的老年患者共256例为研究对象,手术前后使用简易智能状态检查量表(mini mental state examination,MMSE)、蒙特利认知功能评价量表(Montreal cognitive assessment scale,MoCA)评估其认知功能,依据有无POCD将其分成POCD组(70例)以及非POCD组(186例),分析围术期Th17百分比、白细胞介素-17(interleukin-17,IL-17)、白细胞介素-22(Interleukin-22,IL-22)水平和MMSE、MOCA评分的关系。结果POCD组术后1、2、3及7 d的Th17百分比分别为(6.68±0.32)%、(5.76±0.21)%、(4.59±0.43)%和(4.33±0.30)%,均高于非POCD组的Th17百分比[(3.02±0.50)%、(2.70±0.54)%、(0.96±0.39)%和(1.05±0.35)%],差异均具有统计学意义(t值为56.79、46.07、64.52、69.38,P值均<0.05);POCD组术后1、2及7 d的IL-17水平为(19.91±0.65)pg/mL、(17.26±0.66)pg/mL、(15.72±0.29)pg/mL,高于非POCD组IL-17水平[(11.59±0.72)pg/mL、(10.87±0.63)pg/mL、(8.05±0.47)pg/mL],而术后3 d的IL-17水平为(6.25±0.85)pg/mL,低于非POCD组的(8.37±0.27)pg/mL,差异均具有统计学意义(t值为84.56、71.40、127.61、30.28,P值均<0.05);POCD组术后1、2 d的IL-22水平为(19.31±0.59)pg/mL、(18.65±0.31)pg/mL,高于非POCD组的(13.28±0.72)pg/mL、(12.59±0.33)pg/mL,术后3、7 d的IL-22水平为(7.08±0.62)pg/mL、(6.22±0.35)pg/mL,低于非POCD组的(9.05±0.78)pg/mL、(8.03±0.86)pg/mL,差异具有统计学意义(t=62.59、133.10、18.99、21.22,P值均<0.05)。围术期MMSE、MoCA得分同Th17百分比,与IL-17水平与IL-22均水平呈负相关(r值分别为-0.86,-0.73,-0.66,-0.74,-0.67、-0.76,P值均<0.05)。结论全麻髋关节置换术后老年患者POCD及发生同围术期外周血Th17百分比、血清IL-22水平以及IL-17水平升高具有相关性。
Objective To analyze the correlation between postoperative cognitive dysfunction(POCD)and peripheral blood T helper cell 17(Th17)and its effector cytokines in elderly patients after hip arthroplasty under general anesthesia.Methods A total of 256 elderly patients who underwent hip arthroplasty under general anesthesia from January 2018 to January 2020 were selected as the research objects.Mini mental state examination(MMSE)and Monterey cognitive assessment scale(MoCA)were used to evaluate their cognitive function before and after the operation,then all patients were divided into POCD group(70 cases)and non-POCD group(186 cases)according to whether they had POCD or not,and the relationship between Th17 percentage,interleukin(IL)-17,IL-22 levels and MMSE,MOCA score were analyzed.Results One day,two days three day and seven days after operation,the percentage of Th17 in POCD group were(6.68±0.32)%,(5.76±0.21)%,(4.59±0.43)%and(4.33±0.30)%,respectively,which were higher than those in non POCD group[(3.02±0.50)%,(2.70±0.54)%,(0.96±0.39)%,(1.05±0.35)%,there were significant differeces(t=56.79,46.07、64.52,69.38,respectively,all P values<0.05)],the levels of IL-17 in POCD group were(19.91±0.65)pg/mL,(17.26±0.66)pg/mL and(15.72±0.29)pg/mL,which were higher than those in non POCD group[(11.59±0.72)pg/mL,(10.87±0.63)pg/mL,(8.05±0.47)pg/mL],the IL-17 level at 3 d after surgery was(6.25±0.85)pg/mL,which lower than that in the non POCD group[(8.37±0.27)pg/mL],there were significant differeces(t values were 84.56,71.40,127.61,30.28,respectively,all P values<0.05).The IL-22 levels of POCD group were(19.31±0.59)pg/mL and(18.65±0.31)pg/mL,which were higher than those of non-POCD group[(13.28±0.72)pg/mL and(12.59±0.33)pg/mL].IL-22 levels were(7.08±0.62)pg/mL and(6.22±0.35)pg/mL 3 and 7 days after operation,which were lower than those of non-POCD group[(9.05±0.78)pg/mL and(8.03±0.86)pg/mL],there were significant differeces(t values were 62.59,133.10,18.99,21.22,respectively,all P values are<0.05).Perioperati
作者
王海峰
屈常伟
李芳
张雁
Haifeng Wang;Changwei Qu;Fang Li;Yan Zhang(Department of Anesthesiology,Heze City Hospital,Heze 274000,China;Department of Laboratory,Heze City Hospital,Heze 274000,China)
出处
《国际免疫学杂志》
CAS
2021年第6期615-620,共6页
International Journal of Immunology
关键词
认知功能障碍
全麻
辅助性T细胞17
围手术期
Cognitive dysfunction
General anesthesia
Effector cytokines
Helper T cell 17
Perioperative period
