椎管内麻醉对老年髋关节置换术病人术后认知功能及NLRP3炎性小体的影响

doi:10.3969/j.issn.1003-9198.2022.07.017

Abstract

Abstract: Objective To explore the effects of intraspinal anesthesia on the postoperative cognitive function, nucleotidebinding oligomerization domain-like receptor protein 3 (NLRP3) inflammasomes in the elderly patients undergoing hip replacement surgery. Methods A total of 115 elderly patients who underwent elective hip replacement surgery in our hospital from September 2018 to April 2021 were selected. All the patients underwent intraspinal anesthesia. The Mini-mental State Examination (MMSE) was used to evaluate the cognitive function of the patients before and 3 days after operation. According to the occurrence of postoperative cognitive impairment, the patients were divided into cognitive impairment group and non-cognitive impairment group.The risk factors of postoperative cognitive impairment were analyzed by multivariate Logistic regression analysis. The expressions of serum NLRP3 mRNA and cysteine-containing aspartate proteolytic enzyme 1 (Caspase-1) mRNA, and the levels of interleukin (IL)-1β and IL-8 of the two groups were compared before and 3 days after operation. The correlations of MMSE score with the expressions of NLRP3 mRNA and Caspase-1 mRNA and the levels of IL-1β and IL-8 were described by Pearson correlation coefficient. Results The postoperative MMSE score of the patients was significantly lower than that before operation (22.01±3.62 vs 27.45±1.01, P<0.001). The incidence rate of postoperative cognitive impairment was 30.43% (35/115). Multivariate Logistic regression analysis showed that age≥68 years old, diabetes and hypotension during the operation were the risk factors for postoperative cognitive impairment, and education years≥7 years was the protective factor for postoperative cognitive impairment. After operation,the expressions of serum NLRP3 mRNA and Caspase-1 mRNA, and the levels of IL-1β and IL-8 in cognitive impairment group were higher than those before operation and those in non-cognitive impairment group (P＜0.05). In non-cognitive impairment group, there were no statistically significant differences in the levels of the above indicators before and after operation (P>0.05). Pearson correlation analysis showed that postoperative MMSE score was negatively correlated with the expressions of serum NLRP3 mRNA and Caspase-1 mRNA and the levels of IL-1β and IL-8 (r=-0.601, -0.652, -0.501, -0.519, all P<0.05). Conclusions Intraspinal anesthesia has a certain influence on postoperative cognitive function of the elderly patients undergoing hip replacement surgery. The levels of NLRP3 inflammasome indexes in the patients with cognitive impairment after surgery are significantly increased, and the NLRP3 inflammasome-IL-1β signal axis may be involved in the occurrence of postoperative cognitive impairment.

Key words: hip replacement, aged, spinal anesthesia, cognitive function, nucleotidebinding oligomerization domain-like receptor protein 3, inflammasome

CLC Number:

R683.3

ZHANG Chun-li, XU Zhi-xin, HUANG Yu-yuan, CHEN Ding-zhong. Effect of intraspinal anesthesia on postoperative cognitive function and NLRP3 inflammasome in elderly patients undergoing hip replacement[J]. Practical Geriatrics, 2022, 36(7): 720-724.

References

[1] EEDEN Y, TURCK B, EEDEN F. 24 hours stay after hip replacement: implementation of a patient-centered time-based fast-track program[J]. Acta Orthop, 2017, 88(1):24-28.
[2] 郭晓斐, 舒莉, 郭英, 等. 不同人工髋关节置换术治疗创伤性关节炎近期疗效分析[J]. 贵州医药, 2017, 41(6):635-637.
[3] XIAO Q X, LIU Q, DENG R, et al. Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty: POCD in hip arthroplasty[J]. Psychogeriatrics, 2020, 20(4):501-509.
[4] 郭亮, 潘灵辉. 老年患者术后认知功能障碍的研究进展[J]. 中华老年多器官疾病杂志, 2017, 16(4):317-320.
[5] YIN J, ZHAO F P, CHOJNACKI J E, et al. NLRP3 inflammasome inhibitor ameliorates amyloid pathology in a mouse model of Alzheimer's disease[J]. Mol Neurobiol, 2018, 55(3):1977-1987.
[6] BYRNE L, BUCKS R S, WILCOCK G K. Mini mental state examination[J]. Lancet, 2000, 355(9200):314-315.
[7] TOMA T, POKORNA A, JANICEK P, et al. Changes in cognitive functions after total hip arthroplasty[J]. Acta Chir Orthop Traumatol Cech, 2018, 85(2):137-143.
[8] OBERAI T, KILLINGTON M, LAVER K, et al. "Just another piece of paperwork": perceptions of clinicians on delirium screening following hip fracture repair elicited in focus groups[J]. Int Psychogeriatr, 2019, 31(6):877-884.
[9] 张婧, 陈岩, 容俊芳. 术后认知功能障碍影响因素的研究进展[J]. 中华老年多器官疾病杂志, 2017, 16(2):113-116.
[10] 佟颖, 孙乐, 刁志惠, 等. Nek7与NLRP3炎性小体激活机制的研究进展[J]. 生命的化学, 2018, 38(3):367-372.
[11] 张益维, 葛叶盈, 黄自生, 等. 老年髋关节置换患者术后认知功能障碍与血清HIF-1α水平的关系[J]. 浙江医学, 2018, 40(1):71-73.
[12] 刘云霞, 王晋平, 成娜莎. 老年髋部骨折患者人工关节置换术后术后认知功能障碍的风险预测分析[J]. 中国药物与临床, 2018, 18(7):1210-1211.
[13] 阮波, 王瑞, 杨远坚, 等. 从NLRP3炎症小体途径探讨竹节参总皂苷改善自然衰老大鼠认知功能衰退的作用机制[J]. 中国中药杂志, 2019, 44(2):344-349.
[14] REN Q G, GONG W G, ZHOU H, et al. Spatial training ameliorates long-term Alzheimer's disease-like pathological deficits by reducing NLRP3 inflammasomes in PR5 mice[J]. Neurotherapeutics, 2019, 16(2):450-464.
[15] 牛磊, 罗诗诗, 李威, 等. 丰富环境通过抑制NOD样受体蛋白3炎性小体活化缓解脂多糖小鼠的认知障碍[J]. 解剖学报, 2020, 51(2):172-177.
[16] XUE J, JIA P, ZHANG D, et al. TTP488 ameliorates NLRP3 ssociated inflammation, viability, apoptosis, and ROS production in an Alzheimer's disease cell model by mediating the JAK1/STAT3/NFκB/IRF3 pathway[J]. Cell Biochem Funct, 2021, 39(4):555-561.

Effect of intraspinal anesthesia on postoperative cognitive function and NLRP3 inflammasome in elderly patients undergoing hip replacement

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