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乌司他丁对老年手术患者术后早期认知功能障碍的影响：一项系统评价和Meta分析

Effect of Ulinastatin on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Surgery: A Systemic Review and Meta-Analysis.

作者信息

Duan Mei, Liu Fangyan, Fu Huiqun, Feng Shuai, Wang Xue, Wang Tianlong

机构信息

Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Department of Library, Xuanwu Hospital, Capital Medical University, Beijing, China.

出版信息

Front Neurosci. 2021 Jun 21;15:618589. doi: 10.3389/fnins.2021.618589. eCollection 2021.

DOI:10.3389/fnins.2021.618589
PMID:34248475
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8265373/
Abstract

Postoperative cognitive dysfunction (POCD) is associated with neuroinflammation by triggering the systemic inflammatory responses. Related studies have demonstrated that ulinastatin, which is a urinary trypsin inhibitor, inhibited the release of inflammatory mediators and improved postoperative cognitive function in elderly patients undergoing major surgery. However, there are controversial results put forwarded by some studies. This systemic review aimed to evaluate the effect of ulinastatin on POCD in elderly patients undergoing surgery. We searched PubMed, Embase, Cochrane Library, Web of Science, and Ovid to find relevant randomized controlled trials (RCTs) of ulinastatin on POCD in elderly patients undergoing surgery. The primary outcomes included the incidence of POCD and the Mini-Mental State Examination (MMSE) scores. The secondary outcome was the levels of inflammatory cytokines such as tumor necrosis factor (TNF)-α, S100β, C-reactive protein (CRP), interleukin (IL)-6, and IL-10. RevMan 5.3 was used to conduct the meta-analysis. Ten RCTs were included finally. Compared with controls, ulinastatin significantly reduced the incidence of POCD [risk ratio (RR) = 0.29, 95% CI 0.21-0.41, test of RR = 1: = 7.05, < 0.00001]. In addition, patients in the ulinastatin group have lower levels of TNF-α, S100β, CRP, and IL-6 and higher level of IL-10 in serum following surgery. These findings suggested that ulinastatin can be used as an anti-inflammatory drug for POCD prevention in elderly patients undergoing surgery. CRD42019137449.

摘要

术后认知功能障碍（POCD）通过引发全身炎症反应与神经炎症相关。相关研究表明，乌司他丁作为一种尿胰蛋白酶抑制剂，可抑制炎症介质的释放，并改善接受大手术的老年患者的术后认知功能。然而，一些研究提出了有争议的结果。本系统评价旨在评估乌司他丁对接受手术的老年患者POCD的影响。我们检索了PubMed、Embase、Cochrane图书馆、Web of Science和Ovid，以寻找乌司他丁对接受手术的老年患者POCD的相关随机对照试验（RCT）。主要结局包括POCD的发生率和简易精神状态检查表（MMSE）评分。次要结局是肿瘤坏死因子（TNF）-α、S100β、C反应蛋白（CRP）、白细胞介素（IL）-6和IL-10等炎症细胞因子的水平。使用RevMan 5.3进行荟萃分析。最终纳入了10项RCT。与对照组相比，乌司他丁显著降低了POCD的发生率[风险比（RR）=0.29，95%可信区间0.21-0.41，RR检验=1：=7.05，<0.00001]。此外，术后乌司他丁组患者血清中TNF-α、S100β、CRP和IL-6水平较低，IL-10水平较高。这些发现表明，乌司他丁可作为一种抗炎药物用于预防接受手术的老年患者的POCD。CRD42019137449。

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相似文献

[1]
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[3]
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[6]
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引用本文的文献

[1]
Ulinastatin modulates TRPM4 expression and apoptosis to mitigate cognitive dysfunction in aged perioperative neurocognitive disorder rats.

Sci Rep. 2025-5-22

[2]
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Crit Care. 2025-1-29

[3]
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PLoS One. 2024

[4]
The Preventive Effect of Urinary Trypsin Inhibitor on Postoperative Cognitive Dysfunction, on the Aspect of Behavior, Evaluated by Y-Maze Test, via Modulation of Microglial Activity.

Int J Mol Sci. 2024-2-26

[5]
Effects of anesthetic adjunctive agents on postoperative cognitive dysfunction in elderly patients undergoing noncardiac surgery: A Bayesian network meta-analysis.

Brain Behav. 2023-8

[6]
Effects of LncRNA GAS5/miR-137 general anesthesia on cognitive function by TCF4 inflammatory bodies in patients undergoing lumbar spinal canal decompression.

Medicine (Baltimore). 2022-12-9

[7]
Stellate Ganglion Block Improves Postoperative Cognitive Dysfunction in aged rats by SIRT1-mediated White Matter Lesion Repair.

Neurochem Res. 2022-12

[8]
Progress in Research on the Effect of Melatonin on Postoperative Cognitive Dysfunction in Older Patients.

Front Aging Neurosci. 2022-3-9

[9]
Neuroinflammation in perioperative neurocognitive disorders: From bench to the bedside.

CNS Neurosci Ther. 2022-4

本文引用的文献

[1]
The Potential Role of the NLRP3 Inflammasome Activation as a Link Between Mitochondria ROS Generation and Neuroinflammation in Postoperative Cognitive Dysfunction.

Front Cell Neurosci. 2019-2-21

[2]
Ulinastatin May Significantly Improve Postoperative Cognitive Function of Elderly Patients Undergoing Spinal Surgery by Reducing the Translocation of Lipopolysaccharide and Systemic Inflammation.

Front Pharmacol. 2018-10-9

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Med Gas Res. 2016-12-30

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Effects of ulinastatin on early postoperative cognitive function after one-lung ventilation surgery in elderly patients receiving neoadjuvant chemotherapy.

Metab Brain Dis. 2017-4

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