1、 (postoperative cognitive dysfunction, POCD) , , POCD , , , POCD , , ( ) POCD , POCD , , , , POCD , POCD ; ; ; ; ; ;Email: ;Email: (81371216) Inflammation-relevant mechanisms for postoperative cognitive dysfunction and the preventive strategy TANG Yujie OUYANG Wen Department of Anesthesiology, Third
2、 Xiangya Hospital, Central South University; Abstract Postoperative cognitive dysfunction (POCD) is thought to be a mild cognitive disorder.It means that patients without cognitive diseases before surgery suffer from subtle changes in psychomotility, personality, social skills and cognitive function
3、 aft er the surgery.A decline in memory is the core characteristics of these symptoms.POCD is mainly seen in the elderly people following surgery.It can prolong hospital stay, reduce quality of life, increase mortality, and thus aggravate the burden of public health.It is urgent to take precautions
4、to reduce the incidence.The precise mechanism of POCD remains unclear.Previous studies have shown that inflammation plays an important role in it.Sterile surgery can result in peripheral inflammation.Through several pathways, the signals from the peripheral immune response were sent to central syste
5、m.Due to the individual difference, the degree of the central neuroinflammation was also heterogeneous.Some inflammations may lead to the occurrence of POCD.In order to prevent POCD, we should focus on the anti-inflammatory therapy. Keyword postoperative cognitive dysfunction; surgery; inflammation;
6、 elderly; prevention; (postoperative cognitive dysfunction, POCD) , , POCD POCD , 1 POCD POCD , , , 1 : , , 37 d , 3 , , 2 POCD POCD , POCD , (mini-mental state examination, MMSE) - 3 POCD POCD , POCD 2 : 3 , POCD 5.7%, 5.6%, 12.7% , 53%, 6 36%3; , 1 25.8%, 3 9.9%4 POCD , POCD , POCD , POCD POCD , ,
7、 4 POCD 4.1 B1 (high mobility group protein B1, HMGB1) (damage associated molecular patterns, DAMP) , HMGB1 , HMGB1 , Toll (TLR) (receptor for advanced glycation end products, RAGE) , , , , IL- -6, TNF- , HMGB1 , Lin 5 , HMGB1 IL-6 , POCD Cibelli 6 IL- IL-6 , 4.2 , , 4 :1) TNF- NF- , 7, 2 (chemokine
8、 rceptor 2, C C R 2) -1 (monocyte chemotactic protein 1, MCP-1) , 8 2) , , , , ATP 3) , , IL-1 IL-1R1, COX-2 , , 4) Laye 9 , , (LPS) , , IL- 10 LPS IL- , , , , , IL- TNF- , , , 4.3 , POCD , , , , , 11 : , , MHCII TLR4 CD4 , , , , ( ) , , , , , IL-4, IL-10, TGF- , ; , CX3C, CD200, TREM2 12 , , POCD 5
9、 POCD 5.1 , POCD , , :1) , IL-1R IL-1-ra , 13;2) , HMGB1 14, TNF- 15 , , , IL-1-ra 16; , , , , , , , , POCD 5.2 (PGs) COX-1 COX-2 , , A2 , , COX-2 PGs, , , COX-2 , 17 COX-2 , , COX-2 PGs , 18-20 : COX-2 ; PGs , COX-1 PGs, , COX-1 , 21 , COX-2 , (Rv E Rv D) , 22, COX-2 , IL- TNF- COX-1 , 23 ( COX-1 )
10、 (AD) , , - ; AD , ( ) ( ) , COX-2 , COX POCD , , , , COX-1 , COX-1 COX-2 5.3 , 24 : , IL- , IL- -6 24, 25, , ( IL-2, TNF- , Kawano 26 , , , , 27 : , , ; , 2013 ICU , , 28 29 : , , , , , POCD 5.4 , , , , , CD3 T - , , NF- , , Treg Treg IL-4 , M1 M2 Terrando 7 , TNF- NF- , , , AD , Su 30 , POCD , , -
11、3 (PUFA) , , , , , Chiang 31 D2 (Rv D2) GPR18, , AD , Lukiw 32 , , , , , POCD 6 , , , POCD , POCD , , , , , COX PUFA , , , , , 1Hovens IB, Schoemaker RG, van der Zee EA, et al.Thinking through postoperative cognitive dysfunction:How to bridge the gap between clinical and pre-clinical perspectivesJ.B
12、rain Behav Immun, 2012, 26 (7) :1169-1179. 2Monk TG, Weldon BC, Garvan CW, et al.Predictors of cognitive dysfunction after major noncardiac surgeryJ.Anesthesiology, 2008, 108 (1) :18-30. 3Newman MF, Kirchner JL, Phillips-Bute B, et al.Longitudinal assessment of neurocognitive function after coronary
13、-artery bypass surgeryJ.N Engl J Med, 2001, 344 (6) :395-402. 4Moller JT, Cluitmans P, Rasmussen LS, et al.Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study.ISPOCD investigators.International Study of Post-Operative Cognitive DysfunctionJ.Lancet, 1998, 351 (9106) :857-861. 5Lin GX, Wang T, Chen MH, et al.Serum high-mobility group box1 protein correlates with cognitive decline after gastrointestinal surgeryJ.Acta Anaesthesiol Scand, 2014, 58 (6) :668-674. 6Cibelli M, Fidalgo AR
