老年患者髋关节置换术后血清趋化因子CXC配体13的变化

Changes of serum C-X-C motif ligand 13 concentration in senior patients undergoing total hip replacement

目的观察趋化因子CXC配体13(CXCL13)在老年患者髋关节置换术后血清浓度的变化,探讨其在术后认知功能障碍(POCD)中的作用。方法选择髋关节置换手术老年患者80例,男34例,女46例,年龄65~80岁,BMI 18.4~27.3 kg/m2,ASAⅡ或Ⅲ级。于术后1~5 d进行神经心理学测验,分为POCD组和非POCD组。记录术前1 d和术后1、2、3、4、5 d血清C反应蛋白(CPR)、降钙素原(PCT)、IL-6、TNF-α、CXCL13浓度。结果术后1~5 d,有21例(26%)患者发生POCD(POCD组),其余59例患者为非POCD组。与术前1 d比较,术后1~5 d两组患者血清CRP、PCT、IL-6、TNF-α、CXCL13浓度均明显升高(P<0.05)。术后1~5d POCD组患者血清CRP、PCT、IL-6、TNF-α、CXCL13浓度明显高于非POCD组(P<0.05)。结论老年患者髋关节置换术后血清CXCL13浓度在POCD患者中明显升高,是否与POCD有关还需进一步研究。

Objective To investigate the changes of serum C-X-C motif ligand 13 （CXCL13）concentration in senior patients undergoing total hip replacement and its role in post-operative dysfunction （POCD）. Methods Eighty consecutive senior patients aged 65-80 years with BMI 18.4-27.3 kg/m2, ASA physical status Ⅱ or Ⅲ, were recruited and scheduled to undergo hip joint replacement operation. Neuropsychological test was performed 1-5 d after operation and patients were divided into POCD group and non-POCD group. Serum C reactive protein （CPR）, procalcitonin （PCT）, IL-6, TNF-α, CXCL13 concentration were detected 1 d before and 1, 2, 3, 4, 5 d after operation. Results A total of 21 （26%） patients developed POCD 1-5 d after operation （recruited in POCD group）, and the other 59 patients were recruited in non-POCD group. Compared with the time point of 1 d before operation, serum CRP, PCT, IL-6, TNF-α and CXCL13 concentration were higher 1-5 d after operation in all patients （P〈0.05）. The concentrationsof these factors were higher in patients from POCD group than in those from non-POCD group 1-5 d after operation （P〈0.05）. Conclusion The CXCL13 concentration insenior patients undergoing total hip replacement who developed POCD were higher than in those who did not developed POCD. Whether it is correlated with POCD remains further study.