Abstract
Objective To evaluate the relationship between the triggering receptor expressed on myeloid cells (TREM) and postoperative cognitive dysfunction (POCD) in elderly patients. Methods Eighty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients, aged 65-85 yr, weighing 50-80 kg, scheduled for elective total knee replacement under spinal-epidural anesthesia were enrolled in this study.Cerebrospinal fluid (CSF) was extracted after a catheter was successfully inserted into subarachnoid space.Blood samples from the cubital vein was collected before anesthesia induction (T0) and at 24 and 72 h after surgery (T1, 2). The concentrations of TREM1 and TREM2 in CSF and plasma and tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in plasma were measured by enzyme-linked immunosorbent assay.The expression of TREM1, TREM2, IL-6 and TNF-α protein and mRNA in mononuclear cells in peripheral blood was detected using real-time polymerase chain reaction.Neuropsychological test was performed in the the same time period at 1 day before surgery and 7 days after surgery, and the Z score was used to diagnose the development of POCD.The patients were divided into POCD group (P group) and non-POCD group (NP group) according to whether or not POCD happened after surgery. Results The incidence of POCD was 22%.Compared with group NP, the plasma TREM1 concentrations at T1, 2 and plasma IL-6 and TNF-α concentrations at T2 were significantly increased, and the expression of TREM1 mRNA and TNF-α mRNA at T1, 2 and IL-6 mRNA at T2 was up-regulated in group P (P 0.05). There was a higher consistency between plasma and CSF TREM1 concentrations (Cronbach′s Alpha=0.784, P<0.01) and a high consistency between plasma and CSF TREM2 (Cronbach′s Alpha=0.935, P<0.01). Conclusion Up-regulated expression of central and peripheral TREM1 is related to the development of POCD in elderly patients. Key words: Aged; Congnition disorders; Myeloid cells; Receptors, immunologic
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