Aβ_(1-40)、S-100β与老年口腔颌面肿瘤患者术后认知功能障碍的相关性

Correlations of plasma concentrations of β-amyloid peptide and S-100β with postoperative cognitive dysfunction in patients undergoing oral and maxillofacial cancer surgery

目的:观察行口腔颌面肿瘤切除手术的老年患者血浆中Aβ_(1-40)及S-100β在围术期的浓度变化及与术后认知功能障碍的相关性。方法:选择2014年5月—10月择期接受全身麻醉下行口腔颌面肿瘤切除手术的老年患者(年龄≥60岁)115例,所有入选患者于术前1 d、术后7 d行神经心理测试,判定患者是否发生术后认知功能障碍。测定所有患者麻醉诱导前及术后24 h、7 d血浆中Aβ_(1-40)及S-100β蛋白的含量,根据术后7 d是否发生POCD分为POCD组及非POCD组,观察Aβ_(1-40)及S-100β蛋白的含量与POCD的关系。采用SPSS19.0软件包对数据进行统计学分析。结果:POCD组术后7 d POCD的发病例数为37例(32.2%)。与术前比较,POCD组患者术后24 h POCD组患者S-100β含量显著升高(P<0.05);术后24 h血浆中S-100β及Aβ_(1-40)含量显著升高(P<0.05)。与非POCD组相比,POCD组患者术后24 h血浆中S-100β含量显著升高(P<0.05);术后24 h、7 d血浆中Aβ_(1-40)含量显著升高(P<0.05)。结论:Aβ_(1-40)、S-100β在术后升高可能与口腔颌面外科肿瘤切除术后POCD发病密切相关,术后血浆Aβ_(1-40)和S-100β浓度较术前持久增高明显者,发生POCD的可能性增加。Aβ_(1-40)、S-100β或许可作为行口腔肿瘤切除术患者术后POCD发病的预测指标。

PURPOSE： To evaluate the changes of perioperative plasma concentrations of Aβ1-40 and S-100β to determine the relationship with postoperative cognitive dysfunction in elderly patients undergoing oral and maxillofaeial cancer surgeries. METHODS： One hundred and fifteen patients aged at least 60 years undergoing oral and maxillofacial tumor resection were investigated between May 2014 to December 2014.Neuropsychological tests for detecting postoperative cognitive dysfunetion（POCD） were performed one day before surgery and 7 days postoperatively. According to the results of neuropsychologieal tests on day 7, patients were divided into POCD group and non-POCD group.Plasma values of Aβ1-40 and S-100β were determined with enzyme linked immunosorbent assay （ELISA） before anesthesia induction, 24 h and 7 days after surgery. The data were analyzed using SPSS 19.0 software package. RESULTS： According to the definition, POCD was present in 37 of 115 （32.3%） patients 1 week after surgery. Compared with pre-anesthesia, S-100β levels in POCD group were significantly increased （P〈0.05）; the level of Aβ1-40 was significantly higher 24 h after surgery （P〈0.05）. Compared with non-POCD group, S-100β levels were significantly increased 24 h postoperatively （P〈0.05）; Aβ1-40 levels were significantly higher 24 h and 7 days postoperatively （P〈0.05）. CONCLUSIONS： POCD was present in 32.2% of patients on day 7 after oral and maxillofaeial surgeries with general anesthesia. The increasing levels of Aβ1-40, S-100β may be associated with the occurence of POCD. Patients with long-lasting operation and high concentrations of Aβ1-40 and S-100β after surgeries were at a higher risk of POCD. The clinical values of Aβ1-40 and S-100 as predictive measurementsof POCD after oral and maxillofacial cancer surgery appear to be reasonable.