白细胞介素17A与老年腹部手术患者术后认知功能障碍的相关性

Correlation of IL-17A and postoperative cognitive dysfunction in elderly patients undergoing abdominal surgery

目的探讨老年腹部手术患者术后血清白细胞介素(IL)-17A、转化生长因子(TGF)-β、IL-6和肿瘤坏死因子(TNF)-α水平变化及与术后认知功能障碍(POCD)发生的相关性。方法试验组选取红旗医院2015年9月至2016年4月普外科56例老年腹部手术患者,最终50例完成试验,男32例,女18例,年龄65~79岁,ASA分级Ⅰ~Ⅱ级,简易智能量表(MMSE)>23分,所有患者术前1 d和术后7 d进行相同神经认知功能测评。采用国际POCD研究组推荐的Z分法进行患者术后认知功能判定,50例分为POCD组13例和非POCD组37例。分别在麻醉诱导前10 min(T0)、术毕30 min(T1)、术后1 d(T2)、术后3 d(T3)采集静脉血离心取血清酶联免疫吸附试验(ELISA)法检测血清细胞因子IL-17A、TGF-β、IL-6和TNF-α的浓度。结果 IL-17A在T1、T2、T3时,POCD组[(93.85±16.12)、(111.03±17)、(83.76±20.82)ng/L]比非POCD组[(84.59±9.14)、(93.78±10.59)、(73.51±8.15)ng/L]明显升高(P值分别为0.007、0.047、0.004),IL-6在T1、T2时POCD组[(56.63±8.00)、(45.76±7.16)ng/L]比非POCD组[(42.9±7.91)、(36.09±6.92)ng/L]明显升高(P值分别为0.006、0.023),TNF-α在T1、T2时POCD组[(32.19±2.49)、(30.33±1.96)ng/L]比非POCD组[(30.61±1.95)、(30.61±0.77)ng/L]明显升高(P值分别为0.004、0.043),TGF-β在T3时POCD组[(42.81±2.46)μg/L]比非POCD组[(35.90±1.60)μg/L]明显升高(P=0.007)。Spearman相关分析,IL-17A在T2时与复合Z分显著相关(r=0.426,P=0.002),IL-6在T1时与复合Z分显著相关(r=0.346,P=0.014),TNF-α在T1时与复合Z分显著相关(r=0.382,P=0.047),TGF-β在T3时与复合Z分显著相关(r=0.537,P<0.001)。结论老年腹部手术患者术后血清IL-17A、IL-6、TNF-α和TGF-β增高促进POCD发生。

Objective To investigate the correlation between the changes of serum IL-17 A and postoperative cognitive dysfunction in elderly patients undergoing abdominal surgery.Methods 56 cases of elderly patients undergoing abdominal surgery were collected in our hospital from September 2015 to April 2016,among them,50 cases completed the experiment,male 32 and female 18,from 65 to 79 years old,ASA gradeⅠtoⅡ,simple intelligent scale(MMSE)>23 points.All patients were measured neurocognitive assessment 1 day before operation and 7 days after operation.Z score recommended by international postoperative cognitive dysfunction research group.The 50 cases were divided into postoperative cognitive dysfunction(POCD) group 13 cases,and non-POCD group 37 cases.The level ofserum IL-17 A,TGF-β,IL-6 and TNF-α at 10 minutes before(T0),30 minutes after(T1),1 day after(T2),and 3 days after(T3) anesthesia induction,were detected by ELISA.Results IL-17 A in T1,T2,T3 P group [(93.85±16.12),(111.03±17),(83.76±20.82)ng/L] than non-P group [(84.59±9.14),(93.78±10.59),(73.51±8.15) ng/L] obviously increased(P=0.007,P=0.047,P=0.004).IL-6 in T1,T2 P group [(56.63±8.00),(45.76±7.16) ng/L] than non-P group [(42.9±7.91),(36.09±6.92) ng/L] significantly increased(P=0.006,P=0.023),TNF-α in T1,T2 P group [(32.19±2.49),(30.33±1.96) ng/L] than non-P group [(30.61±1.95),(30.61±0.77) ng/L] significantly increased.TGF-β in T3 P group [(42.81±2.46) μg/L] than non-P group [(35.90±1.60) μg/L] significantly increased.Spearman correlation analysis showed that,the levels of IL-17 A at T2,IL-6 at T1,TNF-α at T1 and TGF-β at T3 were significantly related to the composite Z-score,the value of P and the value of r were(P=0.002,P=0.014,P=0.047,P<0.001,r=0.426,r=0.346,r=0.382,r=0.537).Conclusion The increase of serum IL-17 A,IL-6,TNF-α and TGF-β after operation in elderly patients with abdominal surgery promotes is related to the occurrence of postoperative cognitive dysfunction.