外周炎性标志物在术后认知功能障碍（POCD）中的作用：一项荟萃分析。

Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis.

机构信息

Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China.

出版信息

PLoS One. 2013 Nov 13;8(11):e79624. doi: 10.1371/journal.pone.0079624. eCollection 2013.

BACKGROUND

Postoperative cognitive dysfunction (POCD) is common following cardiac and non-cardiac surgery, but the pathogenic mechanisms remain unknown. Many studies suggest that an inflammatory response is a key contributor to POCD. The current meta-analysis shows that the levels of peripheral inflammatory markers are associated with POCD.

METHODS

An online search was performed to identify peer-reviewed studies without language restriction that measured peripheral inflammatory markers of patients with and without POCD, using PubMed, ScienceDirect, SinoMed and the National Knowledge Infrastructure database. Extracted data were analyzed with STATA (version 12).The standardized mean difference (SMD) and the 95% confidence interval (95%CI) were calculated for each outcome using a random effect model. Tests of heterogeneity assessment of bias, and meta-regression were performed in the meta-analysis.

RESULTS

A total of 13 studies that measured the concentrations of peripheral inflammatory markers were included. The current meta-analysis found significantly higher concentrations of S-100β(SMD[95%CI]) (1.377 [0.423, 2.331], p-value < 0.001, N [POCD/non-POCD] =178/391, 7 studies), and interleukin(IL)-6 (SMD[95%CI]) (1.614 [0.603,2.624], p-value < 0.001, N[POCD/non-POCD] = 91/99, 5 studies), but not of neuron specific enolase, interleukin-1β, or tumor necrosis factor-α , in POCD compared with patients without POCD. In meta-regression analyses, a significant positive association was found between the SMD and the preoperative interleukin-6 peripheral blood concentration in patients with POCD (Coef.= 0.0587, p-value=0.038, 5 studies).

CONCLUSIONS

This study shows that POCD is indeed correlated with the concentrations of peripheral inflammatory markers, particularly interleukin-6 and S-100β.

背景

术后认知功能障碍（POCD）在心脏和非心脏手术后很常见，但发病机制尚不清楚。许多研究表明，炎症反应是 POCD 的一个关键因素。目前的荟萃分析表明，外周炎症标志物的水平与 POCD 有关。

方法

通过在线检索，对PubMed、ScienceDirect、SinoMed 和中国知识基础设施数据库中无语言限制的测量 POCD 患者和无 POCD 患者外周炎症标志物的同行评审研究进行了筛选。使用 STATA（版本 12）分析提取的数据。使用随机效应模型计算每个结果的标准化均数差（SMD）和 95%置信区间（95%CI）。在荟萃分析中进行了异质性评估、偏倚检验和荟萃回归检验。

结果

共纳入了 13 项测量外周炎症标志物浓度的研究。本荟萃分析发现，POCD 患者外周 S-100β 浓度明显升高（SMD[95%CI]）（1.377 [0.423, 2.331]，p 值<0.001，N [POCD/non-POCD] =178/391，7 项研究）和白细胞介素（IL）-6 浓度（SMD[95%CI]）（1.614 [0.603,2.624]，p 值<0.001，N[POCD/non-POCD] =91/99，5 项研究）升高，但神经元特异性烯醇化酶、白细胞介素-1β 或肿瘤坏死因子-α 无差异。在荟萃回归分析中，发现 POCD 患者外周血白细胞介素-6 浓度与 SMD 之间存在显著正相关（Coef. = 0.0587，p 值=0.038，5 项研究）。