乌司他丁对老年良性前列腺增生切除术后认知功能的影响

Effect of Ulinastatin on Post-operative Cognition Function in Elderly Patients with Benign Prostatic Hyperplasia

目的探讨乌司他丁对行经尿道前列腺电气化术(TUPV)的良性前列腺增生(BPH)患者认知功能的影响及其可能机制。方法选取2011年7月—2013年10月于赣州市于都县人民医院泌尿外科住院的年龄≥60岁的BPH患者240例,根据随机数字表法将其分为乌司他丁组及对照组各120例。乌司他丁组手术麻醉前使用乌司他丁注射液20万U,术后连续使用3 d,10万U/d。对照组在同一时间使用等量0.9%氯化钠溶液。术前1 d及术后3 d通过蒙特利尔认知评估量表(Mo CA)对患者认知功能进行检测,同时于术前、术毕及术后1、3 d采集患者外周血检测β淀粉样蛋白及Tau蛋白水平。结果术后3 d乌司他丁组Mo CA评分总分及视空间/执行能力、注意及延迟记忆评分与对照组比较,差异均有统计学意义(P<0.05)。两组β淀粉样蛋白及Tau蛋白水平比较,差异有统计学意义(F交互=75.95、210.00,P<0.05)。术毕、术后1 d两组β淀粉样蛋白及Tau蛋白水平间差异有统计学意义,术后3 d两组Tau蛋白水平间差异有统计学意义(P<0.05)。两组术毕、术后1 d、术后3 d与术前,术后1 d与术毕,术后3 d与术后1dβ淀粉样蛋白水平间差异有统计学意义(P<0.05);对照组术毕、术后1 d、术后3 d与术前,术后1 d、术后3 d与术毕,术后3 d与术后1 d Tau蛋白水平间差异有统计学意义(P<0.05);乌司他丁组术毕、术后1 d与术前,术后1 d与术毕,术后3 d与术后1 d Tau蛋白水平间差异有统计学意义。结论乌司他丁对行TUPV的BPH患者的认知功能具有保护作用,可能与其降低β淀粉样蛋白及Tau蛋白水平有关。

Objective To evaluate the effect of ulinastatin on cognition function of benign prostatic hyperplasia（ BPH） patients who had had transurethral prostatic vaporization（ TUPV） and its possible mechanism. Methods From July2011 to October 2013,in Yudu County People＇s Hospital,240 BPH patients aged ≥60 years were enrolled in this study and divided randomly into groups study and control,120 in each. The study group were injected with 200 000 U ulinastatin injection before anesthesia of operation,and 100 000 U / d after operation,3 d. The control group given the same amount of 0. 9% sodium chloride solution at the same time. The patients＇ cognition function was evaluated with Montreal cognitive assessment（ Mo CA） in1 d before and 3 d after operation,the levels of beta-Amyloid protein and Tau protein were determined before operation,at the end of operation,1 d and 3 d after operation. Results There was significant difference in Mo CA total score,the scores of visual-space / implementation capacity,attention and delayed memory of 3 d after operation between the two groups（ P〈0. 05）.There was significant difference in beta-Amyloid protein, Tau protein between the two groups（ F = 75. 95,210. 00, P〈0. 05）. There was difference in beta-Amyloid protein,Tau protein between the two groups at the end of operation,1 d after operation,and in Tau protein 3 d after operation（ P〈0. 05）. The levels of beta-Amyloid protein at the end of operation,1,3 d after opreation were different from those of before operation,those of 1 d after operation from those of at the end of operation,those of 3 d after operation from those of 1 d after operation in the two groups（ P〈0. 05）. The levels of Tau protein at the end of operation,1,3 d after operation differed from those of before operation,those of 1,3 d after operation from those of at the end of operation,those of 3 d after operation from those of 1 d after operation in the control group（ P〈0. 05）. The levels of Tauprotein at the end of operation,1 d after operation were different from those of before operation,those of 1 d after operation from those of at the end of operation,those of 3 d after operation from those of 1 d after operation in the study group. Conclusion Ulinastatin,which can protect the cognition function of the BPH patients having had TUPV,may be associated with the reduction of the levels of beta-Amyloid protein and Tau protein.