血红素加氧酶-1表达增加抑制炎症反应对老年患者术后谵妄的影响

Effect of high level of heme oxygenase-1 inhibiting inflammatory response on postoperative delirium in elderly patients

目的探讨血红素加氧酶-1(HO-1)表达抑制炎症反应对老年患者术后谵妄的影响。方法本研究为临床病例对照研究, 选取2020年12月至2021年12月上海市浦东新区公利医院麻醉科收治的80例行择期全髋关节置换术的老年患者, 男27例, 女53例, 年龄(74.1±5.9)岁, 年龄范围为65~80岁, 采用随机数表法将患者随机分为帕瑞昔布钠组与生理盐水组, 每组40例。帕瑞昔布钠组患者分别于手术前后静脉注射帕瑞昔布钠40 mg(溶于2 ml生理盐水中), 生理盐水组患者分别于手术前后静脉注射生理盐水2 ml。比较两组患者手术前后的分子生物学指标[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、神经丝轻链(NfL)、HO-1]及术后谵妄情况。结果术后1 h、1 d, 帕瑞昔布钠组的TNF-α[(24.0±5.1)pg/ml、(30.8±2.8)pg/ml]、IL-1β[(65.1±5.3)pg/ml、(82.1±9.5)pg/ml]含量低于生理盐水组[(27.4±4.3)pg/ml、(40.2±7.4)pg/ml;(85.0±4.6)pg/ml、(121.5±10.7)pg/ml], HO-1含量[(129.0±43.4)ng/ml、(78.0±14.2)ng/ml]高于生理盐水组[(81.8±13.6)ng/ml、(71.4±14.5)ng/ml];术后3 d, 帕瑞昔布钠组的TNF-α[(20.3±2.3)pg/ml]、IL-1β[(73.4±7.2)pg/ml]含量低于生理盐水组[(29.7±8.2)pg/ml、(102.6±10.2)pg/ml];术后1 h、1 d、3 d, 帕瑞昔布钠组的NfL含量[(83.9±7.9)ng/ml、(91.5±6.1)ng/ml、(99.2±2.8)ng/ml]低于生理盐水组[(95.7±23.5)ng/ml、(121.9±15.0)ng/ml、(133.1±20.5)ng/ml];帕瑞昔布钠组谵妄总发生率[10.0%(4/40)]低于生理盐水组[25.0%(10/40)], 差异均有统计学意义(P<0.05)。结论 HO-1表达增加可抑制炎症反应, 降低老年患者术后谵妄的发生率。

Objective To investigate the mechanism of specific cyclooxygenase-2(COX-2)inhibitor parecoxib reducing postoperative delirium(POD)in elderly patients with hip replacement,which is related to the inhibition of inflammation by the high level of heme oxygenase-1(HO-1).Methods This study was a clinical case-control study,a total of 80 elderly hip replacement patients were received operation at anesthesiology department of Gongli Hospital of Pudong New Area from December 2020 to December 2021,including 27 male and 53 female,aged(74.1±5.9)years old,ranging form 65 to 80 years old.Which were divided into parecoxib sodium group(n=40)and normal saline group(n=40)as the numerical randomly table.Patients in parecoxib sodium group received 40 mg of parecoxib sodium(dissolved in 2 ml of saline)before and after surgery,and patients in normal saline group received 2 ml of saline before and after surgery.The molecular biological indexes[interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),neurofilament light chain(NfL),HO-1]and postoperative delirium were compared between the two groups.Results At 1 h and 1 d after surgery,the content of TNF-α[(24.0±5.1)pg/ml,(30.8±2.8)pg/ml],IL-1β[(65.1±5.3)pg/ml,(82.1±9.5)pg/ml]in parecoxib sodium group were significantly lower than that of normal saline group[(27.4±4.3)pg/ml,(40.2±7.4)pg/ml,(85.0±4.6)pg/ml,(121.5±10.7)pg/ml],HO-1 content[(129.0±43.4)ng/ml,(78.0±14.2)ng/ml]were significantly higher than that in normal saline group[(81.8±13.6)ng/ml,(71.4±14.5)ng/ml].On postoperative day 3,the contents of TNF-α[(20.3±2.3)pg/ml]and IL-1β[(73.4±7.2)pg/ml]in parecoxib sodium group were significantly lower than those in normal saline group[(29.7±8.2)pg/ml,(102.6±10.2)pg/ml].At 1 h,1 d,3 d after surgery,The content of NfL in parecoxib sodium group[(83.9±7.9)ng/ml,(91.5±6.1)ng/ml,(99.2±2.8)ng/ml]were significantly lower than that in normal saline group[(95.7±23.5)ng/ml,(121.9±15.0)ng/ml,(133.1±20.5)ng/ml].The total incidence of delirium in parecoxib sodium group[10.0%(4/40)]was significantly lower than that in normal saline group[25.0%(10/40)],and the differences were statistically significant(P<0.05).Conclusions The high level of HO-1 inhibiting inflammatory response was may significantly related to the down incidence of POD in elderly patients with hip replacement.