结肠癌患者术后认知功能障碍与5-羟色胺受体3B亚基相关性及其对预后的影响
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摘要
目的探讨结肠癌术后患者认知功能障碍与5-羟色胺受体3B亚基相关性及其对预后的影响。方法回顾性分析2013年5月至2017年1月86例均在全麻下行腹腔镜结肠癌切除术资料,根据患者术后是否存在认知功能障碍,将患者分为POCD组(认知功能障碍,n=28)和对照组(无认知功能障碍,n=58),采用SPSS22.0完成数据分析,两组患者心理健康状况等采用独立t检验;5-羟色胺受体3B亚基的基因多态性分析采用卡方检验,患者术后POCD的危险因素采用多因素logistics回归分析。P<0.05表示差异有统计学意义。结果两组患者rs10789970呈多态性分布,POCD组基因型主要表现为CC的野生型比例显著增高(P<0.05)。POCD患者rs10789970为CC、CT和TT的患者智能精神状态评价量表(MMSE)分别为(15.7±3.8)分、(17.8±3.8)分、(20.0±2.8)分(P=0.000)。多因素logistics回归分析显示rs10789970的野生型CC是结肠癌患者术后POCD发生的独立危险因素[1.21(1.02～1.40),P=0.002]。术前两组患者焦虑自我评分和抑郁自我评分均无统计学差异(P>0.05),与对照组比较,POCD组患者术后3 d时焦虑自我评分和抑郁自我评分均显著增高,术后肛门排气时间和住院时间均显著延长,差异均有统计学意义(P<0.05)。结论结肠癌患者术后认知功能障碍发生与rs10789970多态性分布有关,可恶化患者心理健康状况,影响术后康复。
Objective To investigate the relationship between cognitive dysfunction and the 5-serotonin receptor 3 B subunit in patients with colon cancer after curative resection and its effect on the prognosis. Methods From May 2013 to January 2017, 86 patients with colon cancer were retrospectively collected in our hospital. General anesthesia of laparoscopic surgery for colorectal cancer were preformed in all the patients. According to the presence of cognitive dysfunction in the patients after surgery, the patients were divided into a POCD group(cognitive dysfunction, n=28) and a control group(without cognitive impairment, n=58). The data analysis was completed by SPSS22.0. Independent t test was used in the two groups of patients' mental health. The gene polymorphism analysis of 5-serotonin receptor 3 B subunit was analyzed by chi square test. The risk factors of POCD in colon cancer patients after curative resection were analyzed by multiple factor logistic regression analysis. P<0.05 indicated that the difference was statistically significant. Results The polymorphic distribution of rs10789970 was found between the POCD group and the control group, and the proportion of the wild type CC in the POCD group was significantly higher than that of the control group(P<0.05). The MMSE of patients with POCD and CC, CT and TT of rs10789970 were 15.7±3.8、 17.8±3.8 and 20.0±2.8, and the difference was statistically significant(P=0.000). Multiple factor logistic regression analysis showed that the wild type CC of rs10789970 was an independent risk factor for POCD in patients [1.21(1.02～1.40), P=0.002]. There were no significant difference in self-rating anxiety score and self-rating depression score between the two groups(P>0.05). When compared with the control group,the self-rating anxiety score and self-rating depression score in the POCD group were higher than that of the control group on the third day after the operation( P < 0. 05). When compared with the control group,the anal exhaust time and hospitalization time in the POCD group were significantly prolonged( P < 0. 05). Conclusion The occurrence of postoperative cognitive dysfunction in patients with colon cancer after curative resection is related to the polymorphism distribution of rs10789970,which can deteriorate the mental health of the patients and affect the postoperative rehabilitation.
Objective To investigate the relationship between cognitive dysfunction and the 5-serotonin receptor 3 B subunit in patients with colon cancer after curative resection and its effect on the prognosis. Methods From May 2013 to January 2017, 86 patients with colon cancer were retrospectively collected in our hospital. General anesthesia of laparoscopic surgery for colorectal cancer were preformed in all the patients. According to the presence of cognitive dysfunction in the patients after surgery, the patients were divided into a POCD group(cognitive dysfunction, n=28) and a control group(without cognitive impairment, n=58). The data analysis was completed by SPSS22.0. Independent t test was used in the two groups of patients' mental health. The gene polymorphism analysis of 5-serotonin receptor 3 B subunit was analyzed by chi square test. The risk factors of POCD in colon cancer patients after curative resection were analyzed by multiple factor logistic regression analysis. P<0.05 indicated that the difference was statistically significant. Results The polymorphic distribution of rs10789970 was found between the POCD group and the control group, and the proportion of the wild type CC in the POCD group was significantly higher than that of the control group(P<0.05). The MMSE of patients with POCD and CC, CT and TT of rs10789970 were 15.7±3.8、 17.8±3.8 and 20.0±2.8, and the difference was statistically significant(P=0.000). Multiple factor logistic regression analysis showed that the wild type CC of rs10789970 was an independent risk factor for POCD in patients [1.21(1.02～1.40), P=0.002]. There were no significant difference in self-rating anxiety score and self-rating depression score between the two groups(P>0.05). When compared with the control group,the self-rating anxiety score and self-rating depression score in the POCD group were higher than that of the control group on the third day after the operation( P < 0. 05). When compared with the control group,the anal exhaust time and hospitalization time in the POCD group were significantly prolonged( P < 0. 05). Conclusion The occurrence of postoperative cognitive dysfunction in patients with colon cancer after curative resection is related to the polymorphism distribution of rs10789970,which can deteriorate the mental health of the patients and affect the postoperative rehabilitation.
引文
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[13] Wu C, Wang R, Li X, et al. Preoperative Serum MicroRNA-155 Expression Independently Predicts Postoperative Cognitive Dysfunction After Laparoscopic Surgery for Colon Cancer[J]. Med Sci Monit,2016,22(12):4503-4508.
[14] Gupta M, Jain S, Moily NS, et al. Genetic studies indicate a potential target 5-HTR(3B) for drug therapy in schizophrenia patients[J].Am J Med Genet B Neuropsychiatr Genet,2012,159B(8):1006-1008.
[15] Jian J, Li C, Xu J, et al. Associations of serotonin receptor gene HTR3A, HTR3B, and HTR3A haplotypes with bipolar disorder in Chinese patients[J].Genet Mol Res,2016,15(3):881-888.
[16] Park HJ, Kang WS, Chung JH, et al. Association between promoter polymorphism (rs10789970) in 5-hydroxytryptamine receptor 3B and poor concentration in schizophrenia[J]. Psychiatry Res,2014,219(1):235-237.
[17] 简佳. HTR3A及HTR3B Tag SNP与中国汉族双相障碍及其认知功能的关联研究[D]. 济南:山东大学,2016.
[18] 乔冬冬.中国汉族人群HTR3B基因多态性与抑郁障碍及其认知功能的相关性研究[D].济南:山东大学,2015.
[19] Gallegos AM, Streltzov NA, Stecker T. Improving Treatment Engagement for Returning Operation Enduring Freedom and Operation Iraqi Freedom Veterans With Posttraumatic Stress Disorder, Depression, and Suicidal Ideation[J]. J Nerv Ment Dis,2016,204(5):339-343.
[20] Rogers CM, Mallinson T, Peppers D. High-intensity sports for posttraumatic stress disorder and depression: feasibility study of ocean therapy with veterans of Operation Enduring Freedom and Operation Iraqi Freedom[J]. Am J Occup Ther,2014,68(4):395-404.
[2] Garcia-Lopez S. Inflammatory bowel disease in Digestive Disease Week 2016: advances in epidemiology, follow-up, treatment monitoring, optimisation and individual tailoring, and colon cancer prevention[J]. Gastroenterol Hepatol,2016,39 (Suppl 1):29-35.
[3] Wang R, Chen J, Wu G. Variable lung protective mechanical ventilation decreases incidence of postoperative delirium and cognitive dysfunction during open abdominal surgery[J]. Int J Clin Exp Med,2015,8(11):21208-21214.
[4] Zheng XU, Ma Z, Gu X. Plasma levels of tumor necrosis factor-alpha in adolescent idiopathic scoliosis patients serve as a predictor for the incidence of early postoperative cognitive dysfunction following orthopedic surgery[J]. Exp Ther Med,2015,9(4):1443-1447.
[5] Shoair OA, Grasso Ii MP, Lahaye LA, et al. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study[J]. J Anaesthesiol Clin Pharmacol,2015,31(1):30-36.
[6] Biagi JJ, Raphael MJ, Mackillop WJ, et al. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis[J]. JAMA,2011,305(22):2335-2342.
[7] Dos Santos LV, Faria TM, Lima AB, et al. Timing of adjuvant chemotherapy in colorectal cancer[J]. Colorectal Dis,2016,18(9):871-876.
[8] Nachiappan S, Askari A, Mamidanna R, et al. The impact of adjuvant chemotherapy timing on overall survival following colorectal cancer resection[J].Eur J Surg Oncol,2015,41(12):1636-1644.
[9] Livesey MR, Cooper MA, Lambert JJ, et al. Rings of charge within the extracellular vestibule influence ion permeation of the 5-HT3A receptor[J]. J Biol Chem,2011,286(18):16008-16017.
[10] Yamada K, Hattori E, Iwayama Y, et al. Distinguishable haplotype blocks in the HTR3A and HTR3B region in the Japanese reveal evidence of association of HTR3B with female major depression[J]. Biol Psychiatry,2006,60(2):192-201.
[11] Krzywkowski K, Davies PA, Feinberg-Zadek PL, et al.High-frequency HTR3B variant associated with major depression dramatically augments the signaling of the human 5-HT3AB receptor[J]. Proc Natl Acad Sci U S A,2008,105(2):722-727.
[12] Silbert BS, Evered LA, Scott DA. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy[J].Br J Anaesth,2014,113(5):784-791.
[13] Wu C, Wang R, Li X, et al. Preoperative Serum MicroRNA-155 Expression Independently Predicts Postoperative Cognitive Dysfunction After Laparoscopic Surgery for Colon Cancer[J]. Med Sci Monit,2016,22(12):4503-4508.
[14] Gupta M, Jain S, Moily NS, et al. Genetic studies indicate a potential target 5-HTR(3B) for drug therapy in schizophrenia patients[J].Am J Med Genet B Neuropsychiatr Genet,2012,159B(8):1006-1008.
[15] Jian J, Li C, Xu J, et al. Associations of serotonin receptor gene HTR3A, HTR3B, and HTR3A haplotypes with bipolar disorder in Chinese patients[J].Genet Mol Res,2016,15(3):881-888.
[16] Park HJ, Kang WS, Chung JH, et al. Association between promoter polymorphism (rs10789970) in 5-hydroxytryptamine receptor 3B and poor concentration in schizophrenia[J]. Psychiatry Res,2014,219(1):235-237.
[17] 简佳. HTR3A及HTR3B Tag SNP与中国汉族双相障碍及其认知功能的关联研究[D]. 济南:山东大学,2016.
[18] 乔冬冬.中国汉族人群HTR3B基因多态性与抑郁障碍及其认知功能的相关性研究[D].济南:山东大学,2015.
[19] Gallegos AM, Streltzov NA, Stecker T. Improving Treatment Engagement for Returning Operation Enduring Freedom and Operation Iraqi Freedom Veterans With Posttraumatic Stress Disorder, Depression, and Suicidal Ideation[J]. J Nerv Ment Dis,2016,204(5):339-343.
[20] Rogers CM, Mallinson T, Peppers D. High-intensity sports for posttraumatic stress disorder and depression: feasibility study of ocean therapy with veterans of Operation Enduring Freedom and Operation Iraqi Freedom[J]. Am J Occup Ther,2014,68(4):395-404.