老年肺叶切除术患者围术期血清基质金属蛋白酶-9及脂联素浓度与术后谵妄的关系
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摘要
目的评价老年肺叶切除术患者围术期血清基质金属蛋白酶-9(matrix metalloprote-inase-9,MMP-9)及脂联素(adiponectin,ADP)浓度与术后谵妄(postoperative delirium, POD)的相关性。方法选择择期全麻下行肺叶切除术老年患者73例,男38例,女35例,年龄65～80岁,BMI<24 kg/m~2,ASAⅠ或Ⅱ级,术后24、48和72 h采用中文版意识模糊评估量表评估认知功能,根据患者是否发生POD将患者分为两组:POD组和非POD组。于麻醉诱导前5 min(T_0)、气管拔管即刻(T_1)、术后24 h(T_2)、术后48 h(T_3)和术后72 h(T_4)采集静脉血样,测定血清MMP-9及ADP浓度。结果 13例患者发生POD,发生率为17.8%。与T_0时比较,T_1—T_4时POD组血清MMP-9浓度明显升高,血清ADP浓度明显降低(P<0.05);T_1时非POD组MMP-9浓度明显升高,血清ADP浓度明显降低(P<0.05)。T_1—T_4时POD组血清MMP-9浓度明显高于,ADP浓度明显低于非POD组(P<0.05)。结论围术期血清MMP-9浓度升高与ADP浓度下降可能参与老年肺叶切除术患者POD发生的病理生理过程。
Objective To evaluate the correlation between the concentrations of matrix metalloproteinase-9(MMP-9) and adiponectin(ADP) and postoperative delirium(POD) in perioperative serum of elderly patients undergoing lobectomy. Methods Seventy-three elderly patients undergoing lobectomy under general anesthesia, 38 males and 35 females, aged 65-80 years, BMI < 24 kg/m~2, falling into ASA physical status Ⅰ or Ⅱ, were selected in some suitable period. All patients were divided into POD group and non-POD group according to the Chinese Version of Consciousness Assessment Scale at 24 hours, 48 hours, and 72 hours after operation, and their blood samples were collected 5 minutes before induction of anesthesia(T_0), at the time of tracheal extubation(T_1) and at postoperative 24 hours(T_2), 48 hours(T_3), and 72 hours(T_4) to determine the concentrations of MMP-9 and ADP in their serums. Results POD occurred in 19 patients, with the incidence rate of 17.8%. The concentrations of MMP-9 at T_1-T_4 were significantly higher than those before lobectomy in serums in POD group, while the concentrations of ADP in serums were significantly lower than those before lobectomy(P < 0.05). The concentrations of MMP-9 in serums at T_1 were significantly higher than those before lobectomy in non-POD group, while the concentrations of ADP in serums were significantly lower than those before lobectomy(P < 0.05). In the comparison between the two groups, the concentrations of MMP-9 in POD group at T_1-T_4 were significantly higher than those in non-POD group, while the concentrations of ADP in POD group were significantly lower than those in non-POD group(P < 0.05). Conclusion The serum level of MMP-9 is increased and ADP is decreased in perioperative, wich maybe involved in the pathophysiological process of POD in elderly patients undergoing lobectomy.
Objective To evaluate the correlation between the concentrations of matrix metalloproteinase-9(MMP-9) and adiponectin(ADP) and postoperative delirium(POD) in perioperative serum of elderly patients undergoing lobectomy. Methods Seventy-three elderly patients undergoing lobectomy under general anesthesia, 38 males and 35 females, aged 65-80 years, BMI < 24 kg/m~2, falling into ASA physical status Ⅰ or Ⅱ, were selected in some suitable period. All patients were divided into POD group and non-POD group according to the Chinese Version of Consciousness Assessment Scale at 24 hours, 48 hours, and 72 hours after operation, and their blood samples were collected 5 minutes before induction of anesthesia(T_0), at the time of tracheal extubation(T_1) and at postoperative 24 hours(T_2), 48 hours(T_3), and 72 hours(T_4) to determine the concentrations of MMP-9 and ADP in their serums. Results POD occurred in 19 patients, with the incidence rate of 17.8%. The concentrations of MMP-9 at T_1-T_4 were significantly higher than those before lobectomy in serums in POD group, while the concentrations of ADP in serums were significantly lower than those before lobectomy(P < 0.05). The concentrations of MMP-9 in serums at T_1 were significantly higher than those before lobectomy in non-POD group, while the concentrations of ADP in serums were significantly lower than those before lobectomy(P < 0.05). In the comparison between the two groups, the concentrations of MMP-9 in POD group at T_1-T_4 were significantly higher than those in non-POD group, while the concentrations of ADP in POD group were significantly lower than those in non-POD group(P < 0.05). Conclusion The serum level of MMP-9 is increased and ADP is decreased in perioperative, wich maybe involved in the pathophysiological process of POD in elderly patients undergoing lobectomy.
引文
[1] Sarami Foroshani M, Sobhani ZS, Mohammadi MT, et al. Fullerenol nanoparticles decrease blood-brain barrier interruption and brain edema during cerebral ischemia-reperfusion injury probably by reduction of interleukin-6 and matrix metalloproteinase-9 transcription. J Stroke Cerebrovasc Dis, 2018, 27(11): 3053-3065.
[2] Xie H, Huang D, Zhang S, et al. Relationships between matrix metalloproteinase-9 (MMP-9) serum levels and postoperative cognitive dysfunction in elderly patients after general anesthesia. Aging Clin Exp Res, 2016, 28(6):1075-1079.
[3] 谢海辉, 张曙, 李知平,等. 远隔缺血后处理对大鼠心肌缺血再灌注时脂联素水平的影响. 中华麻醉学杂志, 2014, 34(11): 1386-1388.
[4] 徐亚杰, 鲍红光, 王晓亮, 等. 脂联素对脓毒症大鼠肝组织NLRP3炎性小体及炎症因子表达的影响. 临床麻醉学杂志, 2015, 31(9): 905-907.
[5] Sun Y, Zhao D, Yang Y, et al. Adiponectin exerts cardioprotection against ischemia/reperfusion injury partially via calreticulin mediated anti-apoptotic and anti-oxidative actions. Apoptosis, 2017, 22(1): 108-117.
[6] 谢海辉, 张曙, 黄德辉, 等. 依达拉奉对老年患者人工髋关节置换术后血清脂联素及术后认知功能的影响. 临床麻醉学杂志, 2015, 31(4): 346-349.
[7] Xie HH, Zhang S, Huang RC, et al. Impact of anesthesia depth on serum adiponectin, matrix metalloprotein 9 (MMP-9), and postoperative cognitive impairment in elderly patients with general anesthesia. Biomedical Research, 2017, 28 (13): 5316-5321.
[8] Coburn M, Sanders RD, Maze M, et al. The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the preventionof postoperative delirium: a multicentre, randomized clinical trial. Br J Anaesth, 2018, 120(1): 127-137.
[9] 谭刚, 郭向阳, 罗爱伦, 等.老年非心脏手术患者术后谵妄的流行病学调查.协和医学杂志,2011, 2(4):319-325.
[10] Ma L, Zhang H, Liu YZ,et al. Ulinastatin decreases permeability of blood--brain barrier by inhibiting expression of MMP-9 and t-PA in postoperative aged rats. Int J Neurosci, 2016, 126(5):463-468.
[11] Bi J,Shan W, Luo A, et al. Critical role of matrix metallopeptidase 9 in postoperative cognitive dysfunction and age-dependent cognitive decline. Oncotarget, 2017,8(31):51817-51829.
[12] Psilopanagioti A, Papadaki H, Kranioti EF, et al. Expression of adiponectin and adiponectin receptors in human pituitary gland and brain. Neuroendocrinology, 2009, 89(1): 38-47.
[13] Waragai M, Ho G, Takamatsu Y , et al. Importance of adiponectin activity in the pathogenesis of Alzheimer's disease. Ann Clin Transl Neurol, 2017,4(8):591-600.
[14] 徐亚杰, 鲍红光, 王晓亮, 等. 外源性脂联素对术后认知功能障碍老龄小鼠海马AGEs-ROS-ERS通路的影响. 中华麻醉学杂志, 2015, 35(7): 801-804.
[15] 谢海辉, 周建平, 杜巍, 等. 胸椎旁神经阻滞联合全麻对老年开胸手术患者术后认知功能及血清MMP-9、脂联素的影响. 临床麻醉学杂志, 2018, 34(7): 655-659.
[2] Xie H, Huang D, Zhang S, et al. Relationships between matrix metalloproteinase-9 (MMP-9) serum levels and postoperative cognitive dysfunction in elderly patients after general anesthesia. Aging Clin Exp Res, 2016, 28(6):1075-1079.
[3] 谢海辉, 张曙, 李知平,等. 远隔缺血后处理对大鼠心肌缺血再灌注时脂联素水平的影响. 中华麻醉学杂志, 2014, 34(11): 1386-1388.
[4] 徐亚杰, 鲍红光, 王晓亮, 等. 脂联素对脓毒症大鼠肝组织NLRP3炎性小体及炎症因子表达的影响. 临床麻醉学杂志, 2015, 31(9): 905-907.
[5] Sun Y, Zhao D, Yang Y, et al. Adiponectin exerts cardioprotection against ischemia/reperfusion injury partially via calreticulin mediated anti-apoptotic and anti-oxidative actions. Apoptosis, 2017, 22(1): 108-117.
[6] 谢海辉, 张曙, 黄德辉, 等. 依达拉奉对老年患者人工髋关节置换术后血清脂联素及术后认知功能的影响. 临床麻醉学杂志, 2015, 31(4): 346-349.
[7] Xie HH, Zhang S, Huang RC, et al. Impact of anesthesia depth on serum adiponectin, matrix metalloprotein 9 (MMP-9), and postoperative cognitive impairment in elderly patients with general anesthesia. Biomedical Research, 2017, 28 (13): 5316-5321.
[8] Coburn M, Sanders RD, Maze M, et al. The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the preventionof postoperative delirium: a multicentre, randomized clinical trial. Br J Anaesth, 2018, 120(1): 127-137.
[9] 谭刚, 郭向阳, 罗爱伦, 等.老年非心脏手术患者术后谵妄的流行病学调查.协和医学杂志,2011, 2(4):319-325.
[10] Ma L, Zhang H, Liu YZ,et al. Ulinastatin decreases permeability of blood--brain barrier by inhibiting expression of MMP-9 and t-PA in postoperative aged rats. Int J Neurosci, 2016, 126(5):463-468.
[11] Bi J,Shan W, Luo A, et al. Critical role of matrix metallopeptidase 9 in postoperative cognitive dysfunction and age-dependent cognitive decline. Oncotarget, 2017,8(31):51817-51829.
[12] Psilopanagioti A, Papadaki H, Kranioti EF, et al. Expression of adiponectin and adiponectin receptors in human pituitary gland and brain. Neuroendocrinology, 2009, 89(1): 38-47.
[13] Waragai M, Ho G, Takamatsu Y , et al. Importance of adiponectin activity in the pathogenesis of Alzheimer's disease. Ann Clin Transl Neurol, 2017,4(8):591-600.
[14] 徐亚杰, 鲍红光, 王晓亮, 等. 外源性脂联素对术后认知功能障碍老龄小鼠海马AGEs-ROS-ERS通路的影响. 中华麻醉学杂志, 2015, 35(7): 801-804.
[15] 谢海辉, 周建平, 杜巍, 等. 胸椎旁神经阻滞联合全麻对老年开胸手术患者术后认知功能及血清MMP-9、脂联素的影响. 临床麻醉学杂志, 2018, 34(7): 655-659.