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NLRP3 炎性小体参与术后认知功能障碍的进展:从机制到治疗。

NLRP3 inflammasomes are involved in the progression of postoperative cognitive dysfunction: from mechanism to treatment.

机构信息

Department of Anesthesiology, First Hospital of Jilin University, 71 Xinmin Avenue, Changchun, 130021, China.

Department of Neurosurgery, University of Medicine Greifswald, Greifswald, Germany.

出版信息

Neurosurg Rev. 2021 Aug;44(4):1815-1831. doi: 10.1007/s10143-020-01387-z. Epub 2020 Sep 12.

Abstract

Postoperative cognitive dysfunction (POCD) involves patient memory and learning decline after surgery. POCD not only presents challenges for postoperative nursing and recovery but may also cause permanent brain damage for patients, including children and the aged, with vulnerable central nervous systems. Its occurrence is mainly influenced by surgical trauma, anesthetics, and the health condition of the patient. There is a lack of imaging and experimental diagnosis; therefore, patients can only be diagnosed by clinical observation, which may underestimate the morbidity, resulting in decreased treatment efficacy. Except for symptomatic support therapy, there is a relative lack of effective drugs specific for the treatment of POCD, because the precise mechanism of POCD remains to be determined. One current hypothesis is that postoperative inflammation promotes the progression of POCD. Accumulating research has indicated that overactivation of NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasomes contribute to the POCD progression, suggesting that targeting NLRP3 inflammasomes may be an effective therapy to treat POCD. In this review, we summarize recent studies and systematically describe the pathogenesis, treatment progression, and potential treatment options of targeting NLRP3 inflammasomes in POCD patients.

摘要

术后认知功能障碍(POCD)是指患者手术后记忆和学习能力下降。POCD 不仅对术后护理和康复带来挑战,还可能对包括儿童和老年人在内的中枢神经系统脆弱的患者造成永久性脑损伤。其发生主要受手术创伤、麻醉和患者健康状况的影响。目前缺乏影像学和实验诊断方法;因此,只能通过临床观察进行诊断,这可能会低估发病率,导致治疗效果降低。除了对症支持治疗外,针对 POCD 的有效药物相对缺乏,因为 POCD 的精确机制仍有待确定。目前的一个假设是术后炎症促进了 POCD 的进展。越来越多的研究表明,NOD、LRR 和 pyrin 结构域包含蛋白 3(NLRP3)炎性小体的过度激活导致了 POCD 的进展,这表明靶向 NLRP3 炎性小体可能是治疗 POCD 的有效方法。在这篇综述中,我们总结了最近的研究,并系统地描述了靶向 NLRP3 炎性小体治疗 POCD 患者的发病机制、治疗进展和潜在的治疗选择。

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