循環(huán)中生物標(biāo)記物與老年患者術(shù)后認(rèn)知功能減退的相關(guān)性初步研究
發(fā)布時間：2018-09-09 18:01
【摘要】：【研究目的】研究術(shù)后認(rèn)知功能減退組(POCD組)和非術(shù)后認(rèn)知功能減退組(NPOCD組)術(shù)前(PREOP)、術(shù)后一天(POD1)、術(shù)后三天(POD3)患者外周血血漿中五種標(biāo)記物(SOD1、SOD2、Osteopontin、Kallikrein-6、Contactin-1)的水平差異以及POCD組和NPOCD組內(nèi)各時間點(diǎn)血漿中五種生物標(biāo)記物(SOD1、SOD2、Osteopontin、Kallikrein-6、Contactin-1)水平的差異,進(jìn)而探討外周血血漿中五種生物標(biāo)記物的水平和POCD發(fā)生發(fā)展的關(guān)系,從而為POCD的早期診斷、治療和判斷預(yù)后提供可能的機(jī)制�！狙芯糠椒ā窟x擇2015年10月-2016年4月在長海醫(yī)院麻醉科擇期行髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)的老年患者進(jìn)行前瞻性的臨床研究。本研究通過倫理委員會批準(zhǔn)并且與患者簽署知情同意書。納入標(biāo)準(zhǔn):年齡≥65歲、ASAⅠ-Ⅲ級、小學(xué)以上文化水平、術(shù)前MMSE評分≥22分、畫鐘表實驗(CDT)陰性。排除標(biāo)準(zhǔn):ASAIII級、既往患有神經(jīng)系統(tǒng)及精神方面疾病、腦卒中、惡性腫瘤、長期服用精神類藥品、術(shù)前嚴(yán)重焦慮、譫妄及失訪。本研究分為兩組,術(shù)后發(fā)生POCD(POCD組)和術(shù)后未發(fā)生POCD(NPOCD組)。并且記錄患者相關(guān)信息,包括:年齡、性別、身高、體重、身高體重指數(shù)(BMI)、既往病史、文化水平、手術(shù)時間、術(shù)前MMSE評分、術(shù)前焦慮評分、術(shù)后疼痛評分。術(shù)前我們應(yīng)用SAS/SDS來排除嚴(yán)重焦慮和抑郁的患者,應(yīng)用CAM-ICU量表排除譫妄,應(yīng)用MMSE、畫鐘表實驗(CDT)評估患者基礎(chǔ)認(rèn)知功能;術(shù)后一天(POD1)、術(shù)后三天(POD3)應(yīng)用MMSE量表評估患者術(shù)后認(rèn)知功能;術(shù)后一天(POD1)、術(shù)后三天(POD3)應(yīng)用CAM-ICU量表排除譫妄;應(yīng)用視覺模擬評分(VAS)評估術(shù)后疼痛。分別于PREOP、POD1、POD3采取入組患者空腹外周靜脈血存于抗凝管中。使用The MILLIPLEX?MAP Human Neurological Disorders Panel 3 kits(Millipore,Billerica,Massachusetts)檢測外周血血漿中的生物標(biāo)記物的濃度�；颊邇山M間計量資料采用均數(shù)±標(biāo)準(zhǔn)差表示,計數(shù)資料采用頻數(shù)、百分比表示,實驗數(shù)據(jù)采用SPSS19.0統(tǒng)計軟件包進(jìn)行數(shù)據(jù)結(jié)果分析。兩組間基本信息計量資料采用t檢驗,計數(shù)資料采用卡方檢驗。兩組生物標(biāo)記物的水平整體比較采用重復(fù)測量資料方差分析,組內(nèi)時間點(diǎn)兩兩比較采用LSD-t檢驗,同一時間點(diǎn)組間比較采用t檢驗,p0.05為差異有統(tǒng)計學(xué)意義�！窘Y(jié)果】1.本研究共納入45例患者,18例(40%)患者在術(shù)后一天、三天均出現(xiàn)MMSE評分下降,且18例患者術(shù)后三天發(fā)生POCD,POCD組和NPOCD組兩組間患者基本特征差異無統(tǒng)計學(xué)意義(p0.05)。2.患者術(shù)前血漿中Kallikrein-6的基礎(chǔ)水平兩組間無顯著差異(p0.05),術(shù)后一天POCD組患者血漿中Kallikrein-6的水平顯著低于NPOCD組(p0.05),術(shù)后三天POCD組患者血漿中Kallikrein-6的水平顯著低于NPOCD組(p0.01),且POCD組患者術(shù)后一天、術(shù)后三天患者血漿中Kallikrein-6的水平均較術(shù)前顯著降低(p0.01)。3.患者術(shù)前、術(shù)后一天、術(shù)后三天血漿中l(wèi)n(SOD1)、ln(SOD2)、ln(Osteopontin)、Contactin-1的水平兩組間均無明顯差異(p0.05)。POCD組患者術(shù)后三天血漿中l(wèi)n(SOD1)的水平較術(shù)前顯著降低(p0.05);POCD組患者術(shù)后一天、術(shù)后三天患者血漿中l(wèi)n(Osteopontin)的水平均較術(shù)前顯著升高(p0.05);并且POCD組患者術(shù)后一天、術(shù)后三天患者血漿中Contactin-1的水平均較術(shù)前顯著降低(p0.01);而POCD組患者術(shù)后一天、術(shù)后三天血漿中l(wèi)n(SOD2)的水平與術(shù)前相比均無顯著差異(p0.05)�！窘Y(jié)論】本研究發(fā)現(xiàn)18例(40%)擇期行髖關(guān)節(jié)和膝關(guān)節(jié)置換術(shù)的老年患者術(shù)后一天、術(shù)后三天均出現(xiàn)MMSE評分下降,且18例患者術(shù)后三天發(fā)生POCD。POCD組和NPOCD組兩組間患者基本特征差異無統(tǒng)計學(xué)意義。術(shù)后血漿中Kallikrein-6的水平可能與老年患者早期術(shù)后認(rèn)知功能減退的發(fā)生發(fā)展相關(guān),而POCD組患者血漿中標(biāo)記物(SOD1、Osteopontin、Kallikrein-6、Contactin-1)的表達(dá)水平可能隨術(shù)后認(rèn)知功能減退而不斷變化。
[Abstract]:[Objective] To study the difference of five markers (SOD1, SOD2, Osteopontin, Kallikrein-6, Contactin-1) in peripheral blood plasma of patients with postoperative cognitive impairment (POCD) and non-postoperative cognitive impairment (NPOCD) before surgery (PREOP), one day after surgery (POD1), and three days after surgery (POD3), and the blood levels of POCD and NPOCD at different time points. The differences of plasma levels of five biomarkers (SOD1, SOD2, Osteopontin, Kallikrein-6, Contactin-1) were studied to explore the relationship between the levels of five biomarkers in peripheral blood plasma and the occurrence and development of POCD, thus providing a possible mechanism for the early diagnosis, treatment and prognosis of POCD. [Methods] Oct. 2015-2014 was selected as the study area. A prospective clinical study was conducted in elderly patients undergoing elective hip and knee arthroplasty in the anesthesiology department of Changhai Hospital in June. The study was approved by the Ethics Committee and informed consent was signed with the patients. Negative. Exclusive criteria: ASAIII, previous neurological and psychiatric disorders, stroke, malignant tumor, long-term psychotropic drugs, preoperative severe anxiety, delirium and loss of visit. This study was divided into two groups, POCD (POCD group) occurred after surgery and no POCD (NPOCD group) occurred after surgery. Preoperative SAS / SDS was used to exclude patients with severe anxiety and depression, CAM - ICU was used to exclude delirium, MMSE and CDT were used to evaluate the patients'basic cognitive function. Postoperative cognitive function was assessed with MMSE on day 1 (POD1) and day 3 (POD3); delirium was excluded by CAM-ICU on day 1 (POD1) and postoperative pain was assessed by visual analogue scale (VAS). Fasting peripheral venous blood was stored in anticoagulant tubes on day 1 (POD1) and day 3 (POD3). The MILLIPLEX?MAP H was used. The concentration of biomarkers in peripheral blood plasma was measured by the uman Neurological Disorders Panel 3 kits (Millipore, Billerica, Massachusetts). The measurements between the two groups were expressed by mean (+) standard deviation. The counts were expressed by frequency and percentage. The experimental data were analyzed by SPSS19.0 statistical software package. The basic information was measured by t-test, and the counting data by chi-square test. The levels of biomarkers in the two groups were compared by analysis of variance of repeated measurements. The time points in the two groups were compared by LSD-t test, and the time points in the same group were compared by t-test. Among 45 patients, 18 (40%) had a decrease in MMSE score one day and three days after surgery, and there was no significant difference in the basic characteristics between the POCD group and NPOCD group (p0.05). 2. There was no significant difference in the baseline level of Kallikrein-6 in the preoperative plasma between the two groups (p0.05). The plasma levels of Kallikrein-6 in POCD group were significantly lower than those in NPOCD group (p0.05). The plasma levels of Kallikrein-6 in POCD group were significantly lower than those in NPOCD group three days after operation (p0.01). The plasma levels of Kallikrein-6 in POCD group were significantly lower than those in NPOCD group one day after operation and three days after operation (p0.01). 3. The levels of LN (SOD1), ln (SOD2), ln (Osteopontin) and Contactin-1 were not significantly different between the two groups (p0.05). The levels of LN (SOD1) in plasma of POCD group were significantly lower than those of pre-operation three days after operation (p0.05); the levels of LN (Osteopontin) in plasma of POCD group were significantly higher than those of pre-operation one day and three days after operation (p0.05). The plasma levels of Contactin-1 were significantly lower one day and three days after surgery than those before surgery (p0.01), but there was no significant difference in the plasma levels of LN (SOD2) between the POCD group and the preoperative group on the first day and three days after surgery (p0.05). [Conclusion] 18 (40%) elderly patients undergoing hip and knee arthroplasty were found in this study. There was no significant difference in the basic characteristics between the POCD. POCD group and NPOCD group. The level of Kallikrein-6 in plasma after surgery may be related to the occurrence and development of early postoperative cognitive impairment in elderly patients, while the level of plasma markers in POCD group (P The expression levels of SOD1, Osteopontin, Kallikrein-6 and Contactin-1 may change with postoperative cognitive impairment.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
本文編號：2233149
[Abstract]:[Objective] To study the difference of five markers (SOD1, SOD2, Osteopontin, Kallikrein-6, Contactin-1) in peripheral blood plasma of patients with postoperative cognitive impairment (POCD) and non-postoperative cognitive impairment (NPOCD) before surgery (PREOP), one day after surgery (POD1), and three days after surgery (POD3), and the blood levels of POCD and NPOCD at different time points. The differences of plasma levels of five biomarkers (SOD1, SOD2, Osteopontin, Kallikrein-6, Contactin-1) were studied to explore the relationship between the levels of five biomarkers in peripheral blood plasma and the occurrence and development of POCD, thus providing a possible mechanism for the early diagnosis, treatment and prognosis of POCD. [Methods] Oct. 2015-2014 was selected as the study area. A prospective clinical study was conducted in elderly patients undergoing elective hip and knee arthroplasty in the anesthesiology department of Changhai Hospital in June. The study was approved by the Ethics Committee and informed consent was signed with the patients. Negative. Exclusive criteria: ASAIII, previous neurological and psychiatric disorders, stroke, malignant tumor, long-term psychotropic drugs, preoperative severe anxiety, delirium and loss of visit. This study was divided into two groups, POCD (POCD group) occurred after surgery and no POCD (NPOCD group) occurred after surgery. Preoperative SAS / SDS was used to exclude patients with severe anxiety and depression, CAM - ICU was used to exclude delirium, MMSE and CDT were used to evaluate the patients'basic cognitive function. Postoperative cognitive function was assessed with MMSE on day 1 (POD1) and day 3 (POD3); delirium was excluded by CAM-ICU on day 1 (POD1) and postoperative pain was assessed by visual analogue scale (VAS). Fasting peripheral venous blood was stored in anticoagulant tubes on day 1 (POD1) and day 3 (POD3). The MILLIPLEX?MAP H was used. The concentration of biomarkers in peripheral blood plasma was measured by the uman Neurological Disorders Panel 3 kits (Millipore, Billerica, Massachusetts). The measurements between the two groups were expressed by mean (+) standard deviation. The counts were expressed by frequency and percentage. The experimental data were analyzed by SPSS19.0 statistical software package. The basic information was measured by t-test, and the counting data by chi-square test. The levels of biomarkers in the two groups were compared by analysis of variance of repeated measurements. The time points in the two groups were compared by LSD-t test, and the time points in the same group were compared by t-test. Among 45 patients, 18 (40%) had a decrease in MMSE score one day and three days after surgery, and there was no significant difference in the basic characteristics between the POCD group and NPOCD group (p0.05). 2. There was no significant difference in the baseline level of Kallikrein-6 in the preoperative plasma between the two groups (p0.05). The plasma levels of Kallikrein-6 in POCD group were significantly lower than those in NPOCD group (p0.05). The plasma levels of Kallikrein-6 in POCD group were significantly lower than those in NPOCD group three days after operation (p0.01). The plasma levels of Kallikrein-6 in POCD group were significantly lower than those in NPOCD group one day after operation and three days after operation (p0.01). 3. The levels of LN (SOD1), ln (SOD2), ln (Osteopontin) and Contactin-1 were not significantly different between the two groups (p0.05). The levels of LN (SOD1) in plasma of POCD group were significantly lower than those of pre-operation three days after operation (p0.05); the levels of LN (Osteopontin) in plasma of POCD group were significantly higher than those of pre-operation one day and three days after operation (p0.05). The plasma levels of Contactin-1 were significantly lower one day and three days after surgery than those before surgery (p0.01), but there was no significant difference in the plasma levels of LN (SOD2) between the POCD group and the preoperative group on the first day and three days after surgery (p0.05). [Conclusion] 18 (40%) elderly patients undergoing hip and knee arthroplasty were found in this study. There was no significant difference in the basic characteristics between the POCD. POCD group and NPOCD group. The level of Kallikrein-6 in plasma after surgery may be related to the occurrence and development of early postoperative cognitive impairment in elderly patients, while the level of plasma markers in POCD group (P The expression levels of SOD1, Osteopontin, Kallikrein-6 and Contactin-1 may change with postoperative cognitive impairment.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
【參考文獻(xiàn)】
中國期刊全文數(shù)據(jù)庫 前6條
1 陳靈科;鄭麗;吳廣喜;鄭華容;陳杰;王祥瑞;俞衛(wèi)鋒;蘇殿三;;60歲以上行髖關(guān)節(jié)或膝關(guān)節(jié)置換術(shù)患者術(shù)后認(rèn)知功能障礙的發(fā)生率和危險因素[J];上海醫(yī)學(xué);2016年02期
2 林咸明;陳麗萍;姚旭;;不同時程電針預(yù)處理對腦缺血再灌注大鼠血腦屏障基質(zhì)金屬蛋白酶-9、血管內(nèi)皮生長因子的影響[J];針刺研究;2015年01期
3 張媛;錢燕寧;斯妍娜;鮑紅光;周建偉;;結(jié)直腸手術(shù)后認(rèn)知功能障礙患者血清細(xì)胞因子的差異表達(dá)[J];細(xì)胞與分子免疫學(xué)雜志;2015年02期
4 王鐵全;薛杰;寇立華;劉禹含;史洪淼;;中年與老年全麻非心臟手術(shù)術(shù)后認(rèn)知功能障礙的比較[J];中國衛(wèi)生產(chǎn)業(yè);2013年24期
5 崔勤濤;付慶林;韓培立;張杰;;非體外循環(huán)冠狀動脈旁路移植術(shù)后認(rèn)知功能障礙的影響因素[J];中華心血管病雜志;2012年02期
6 陳方敏;石家齊;谷江;賈本忠;李登寶;楊建軍;姜錫男;嚴(yán)波;任德帥;梁駿;畢磊;肖峰;;經(jīng)尿道前列腺電切術(shù)后并發(fā)認(rèn)知功能障礙的高危因素分析[J];南京醫(yī)科大學(xué)學(xué)報(自然科學(xué)版);2010年07期
，本文編號：2233149
本文鏈接：http://www.sikaile.net/yixuelunwen/waikelunwen/2233149.html
最近更新
教材專著
