Department of Anesthesiology, Beijing Military General Hospital, Beijing, China.
Am J Med Sci. 2013 May;345(5):355-60. doi: 10.1097/MAJ.0b013e31825a674d.
Amnestic mild cognitive impairment (aMCI) is thought to be a transitional stage between normal aging and the development of Alzheimer's disease (AD). Recent studies have suggested that the inhalational anesthetic isoflurane can induce caspase activation and apoptosis, increase aggregates of β-amyloid (Aβ) levels, and enhance Aβ aggregation. The aim of this study was to investigate whether previous exposure to different anesthetics induced progression of aMCI.
A prospective, randomized parallel-group study was completed with 180 patients with aMCI who were randomly assigned to a sevoflurane, propofol or lidocaine epidural anesthesia group (n = 60 per group) during an L3 to L4 or an L4 to L5 spinal surgery. Sixty additional outpatients with aMCI served as a control group. Before surgery, all subjects underwent a neuropsychological assessment. Cerebrospinal fluid (CSF) was obtained by lumbar puncture, and neuropsychological assessments were completed in the clinic. CSF Aβ42, total tau and phosphorylated tau181 were quantitatively assayed. The neuropsychological assessments were repeated after 2 years.
Two years after anesthesia, the number of AD cases that emerged did not differ significantly between the groups. However, the number of cases of progressive MCI was greater in the sevoflurane group than in the control group. Age correlated linearly with aMCI progression, whereas sex did not. Both patients with AD and progressive MCI had decreased CSF Aβ42, increased total tau and increased phosphorylated tau levels compared with those with stable MCI and the controls.
Inhaled sevoflurane accelerated the progression of aMCI to progressive MCI in this selected Chinese population.
遗忘型轻度认知障碍（aMCI）被认为是正常衰老与阿尔茨海默病（AD）发展之间的过渡阶段。最近的研究表明，吸入麻醉剂异氟醚可诱导半胱天冬酶激活和细胞凋亡，增加β-淀粉样蛋白（Aβ）水平的聚集，并增强 Aβ聚集。本研究旨在探讨先前接触不同麻醉剂是否会导致 aMCI 的进展。
采用前瞻性、随机平行分组研究，将 180 例 aMCI 患者随机分为七氟醚、丙泊酚或利多卡因硬膜外麻醉组（每组 60 例），在 L3 至 L4 或 L4 至 L5 脊髓手术中接受麻醉。另外 60 例门诊就诊的 aMCI 患者作为对照组。手术前，所有患者均进行神经心理学评估。通过腰椎穿刺获取脑脊液（CSF），并在诊所完成神经心理学评估。定量检测 CSF Aβ42、总 tau 和磷酸化 tau181。麻醉后 2 年重复神经心理学评估。
麻醉后 2 年，各组 AD 病例数无显著差异。然而，与对照组相比，七氟醚组出现进展性 MCI 的病例数更多。年龄与 aMCI 进展呈线性相关，而性别则无相关性。与稳定 MCI 患者和对照组相比，AD 患者和进展性 MCI 患者的 CSF Aβ42 降低，总 tau 升高，磷酸化 tau 水平升高。
在本研究的中国人群中，吸入七氟醚加速了 aMCI 向进展性 MCI 的进展。
