全身麻醉术后认知功能障碍与血小板β-淀粉样蛋白变化的关系

Relationship between postoperative cognitive dysfunction and the expression of Amyloid-β protein in the platelet under general anesthesia

目的观察老年患者全身麻醉术后认知功能障碍(POCD)与血小板β-淀粉样蛋白(Aβ)的关系。方法选择全身麻醉下行普外科手术患者60例,年龄>60岁,在术前1d和术后7d采用成套神经心理测验(BCAI)评价患者认知功能,并测定血小板Aβ、β-分泌酶、α-分泌酶和Aβ前体蛋白(APP)水平。结果术后7d有18例(30%)患者发生POCD(POCD组),另42例为非POCD组。术前两组Aβ、β-分泌酶、α-分泌酶、APP比值差异无统计学意义。与术前比较,术后7dPOCD组Aβ表达明显增高(P<0.05),β-分泌酶、α-分泌酶、APP比值明显降低(P<0.05);非POCD组Aβ、β-分泌酶、α-分泌酶、APP比值差异无统计学意义。结论 POCD的发生与血小板β-淀粉样蛋白的表达增高有关。

Objective To investigate the relationship between the expression of amyloid-βprotein（Aβ）in the platelet and postoperative cognitive dysfunction（POCD）under general anesthesia.Methods The cognitive function of 60patients（〉60years old）undergoing operation under general anesthesia was evaluated by a battery of cognitive assessment instruments（BCAI）1dpreoperatively and 7dpostoperatively.The levels of Aβ,β-secretase,α-secretase,APP ratio in the platelet were detected at the time points set in advance.Results The incidence of POCD was 30%.The expressions ofα-secretase,β-secretase,APP radio（120-130kD）/110 kD,Aβpreoperation in POCD group and in noncognitive dysfunction group were not different.Levels of Aβ7-day postoperation were significantly higher than preoperation in POCD group（P〈0.05）.Levels ofα-secretase,β-secretase,APP radio（120-130kD）/110 kD 7-day postoperation were significantly lower than preoperation in cognitive dysfunction group（P〈0.05）.Compared with preoperation,the expressions ofα-secretase,β-secretase,APP radio（120-130kD）/110 kD,Aβ7-day postoperation in non-cognitive dysfunction group were not different.Conclusion POCD is associated with high expression of Aβin the platelet.