肝移植术后认知功能障碍及其与β-淀粉样蛋白和C-反应蛋白关系地研究(全文).doc

09年会--中青年论文大赛参赛 中青年优秀论文评奖 肝移植术后认知功能障碍及其与β-淀粉样蛋白和C-反应蛋白关系的研究 上海交通大学医学院附属仁济医院 200001 李兴 闻大翔 杭燕南李兴 Lx_fly2001@163.com） 闻大翔 wdxrwj@126.com） 麻醉临床与基础研究 摘要 目的 研究肝移植患者术后认知功能障碍（POCD）及其与β-淀粉样蛋白（β-AP）和C-反应蛋白（CPR）变化的关系。 方法 对2008年7月至2009年2月上海交通大学医学院附属仁济医院25例肝移植手术患者应用神经心理学组测试进行POCD评定；并分别于麻醉诱导后、无肝期30min、新肝期3h、术毕24h抽取颈内静脉血采用ELISA方法测定β-AP、CRP含量。 结果 肝移植患者POCD的发生率为44%（11/25）。其相关影响因素主要有重肝、高MELD评分、肝功能child-pugh分级C级等。与非POCD组相比POCD组术毕24hβ-AP、CRP明显升高；与术前相比，POCD组术毕24hβ-AP、CRP均明显升高。 结论 肝移植患者发生POCD可能与术后β-AP、CRP含量升高有关，β-AP可以作为POCD的预测指标。 关键词：肝移植，β-淀粉样蛋白，C-反应蛋白，术后认知功能障碍 a study of the role of beta amyloid protein AND C-REATIVE PROTEIN changes in the development of postoperative cognitive dysfunction（POCD） in patients undergoing liver transplantation Abstract Objective: To investigate the role of beta amyloid protein(β-AP) and C-reactive Protein(CRP) changes in the development of postoperative cognitive dysfunction（POCD） in patients undergoing liver transplantation． Methods: To determinate POCD with Neuropsychological Battery Tests(NBTs) in 25 patients undergoing liver transplantation，in Shanghai Jiaotong University Renji Hospital, from July 2008 to February 2009.Blood samples were collected from central vein for determination of plasma β-AP and CRP concentrations by ELISA before induction of anesthesia ,at 30min of Anhepatic Phase,3h of New Liver Phase,and 24h after Postoperative． Results: The morbidity of POCD is 44% （11/25）in patients undergoing liver transplantation.The severe hepatitis and high MELD score and?liver function child-pugh class C are the important related influencing factors．Compared with No POCD group,the serum β-AP and CRP concentration were significantly increased at 24h after Postoperative; Compared with Preoperative, the serum β-AP and CRP concentration were significantly increased at 24h after Postoperative in POCD group. Conclusions: The serum β-AP and CRP concentration increases significantly at 24h after Postoperative and