α2A受体激动剂改善老年脑肿瘤患者术后认知功能障碍的研究

Study of α2A receptor agonists on improving postoperative cognitive dysfunction in elderly patients with brain tumor surgery by inhibiting inflammatory response and oxidative stress

目的研究α2A受体激动剂对老年脑肿瘤手术患者认知功能及炎症反应、氧化应激的影响,探讨α2A受体激动剂改善老年脑肿瘤手术患者术后认知功能障碍的可能机制。方法选择浙江省人民医院2013年6月—2017年12月老年脑肿瘤手术患者160例,根据随机数字法分为对照组和右美托咪定组,每组80例。右美托咪定组术前泵入α2A受体激动剂右美托咪定至手术结束。采用简易智力状态检查量表(easy intelligence status checklist,MMSE)评分测定患者认知功能,采用酶联免疫吸附实验(enzyme-linked immunosuppression adsorption,ELISA)测定血清白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平,采用硫代巴比妥酸染色法测定血清丙二醛(malondialdehyde,MDA)浓度,采用黄嘌呤氧化酶法测定血清超氧化物歧化酶(superoxide dismutase,SOD)活性。结果右美托咪定组患者术后认知功能障碍发生率(18.75%)低于对照组(38.75%,χ~2=7.811,P=0.005)。手术前,2组患者MMSE评分、血清IL-6、TNF-α水平、血清MDA浓度和SOD活性比较差异无统计学意义(均P>0.05);手术后,右美托咪定组MMSE评分[(26.71±2.04)分]、SOD活性[(88.42±8.74)U/mL]高于对照组(均P<0.05),血清IL-6[(42.13±3.38)pg/mL]、TNF-α水平[(16.27±1.95)pg/mL]和MDA浓度[(5.14±1.27)nmol/mL]低于对照组(均P<0.05)。结论α2A受体激动剂通过抑制炎症反应和氧化应激改善老年脑肿瘤手术患者术后认知功能障碍。

Objective To study the effects of α2 A receptor agonists on cognitive function, inflammatory response and oxidative stress in elderly patients with brain tumor surgery, and to explore the possible mechanism of α2 A receptor agonists on improving postoperative cognitive dysfunction in elderly patients with brain tumor surgery. Methods A total of 160 patients with brain tumor surgery from June 2013 to December 2017 treated in Wangjiangshan District of Zhejiang Provincial People’s Hospital were selected, and were divided into the control group and the dexmedetomidine group according to the random number method, with 80 cases in each group. The dexmedetomidine group patients were preoperatively pumped with the α2 A receptor agonist dexmedetomidine until the end of surgery. The MMSE scores were used to measure cognitive function of the patients. The serum IL-6 and TNF-α levels were determined by ELISA. The serum MDA concentration was determined by thiobarbituric acid staining. The serum SOD activity was measured by xanthine oxidase method. Results The incidence of postoperative cognitive dysfunction in the dexmedetomidine group(18.75%) was lower than that in the control group(38.75%,χ^2=7.811, P=0.005). There were no significant differences in MMSE scores, serum IL-6 and TNF-α levels, serum MDA concentrations and SOD activities between the two groups before surgery(all P>0.05). After surgery, the MMSE score [(26.71±2.04) scores] and SOD activity [(88.42±8.74) U/mL] in the dexmedetomidine group were higher than those in the control group(all P<0.05), the serum IL-6 [(42.13±3.38) pg/mL], TNF-α levels [(16.27±1.95) pg/mL] and MDA concentrations [(5.14±1.27) nmol/mL] were lower than that in the control group(all P<0.05). Conclusion α2 A receptor agonists improve postoperative cognitive dysfunction in elderly patients with brain tumor surgery by inhibiting inflammatory response and oxidative stress.