免疫組化下的α核蛋白（A圖箭頭所指為正常型,，B圖箭頭所指為磷酸化型）
術(shù)后譫妄的臨床特性與α核蛋白相關(guān)認(rèn)知障礙（如路易體癡呆和帕金森病癡呆）的核心特征相關(guān)。胃癌患者胃切除術(shù)后譫妄的α核蛋白病理機(jī)制尚不明確,。為此,，韓國延世醫(yī)學(xué)院神經(jīng)科的Mun Kyung Sunwoo博士等人進(jìn)行了一項(xiàng)研究，研究結(jié)果在線發(fā)表在2013年1月30日的Neurology雜志上,。研究結(jié)果發(fā)現(xiàn)：胃的潛在的α核蛋白病理機(jī)制與術(shù)后譫妄相關(guān),，提示術(shù)后譫妄是一種α核蛋白相關(guān)認(rèn)知障礙的臨床前期表現(xiàn),。
研究人員從大學(xué)醫(yī)院2007-2011年因原發(fā)性胃癌行胃大部切除術(shù)的患者中選擇出現(xiàn)和沒有出現(xiàn)譫妄的患者。對肌間神經(jīng)叢中正常和磷酸化形式的α核蛋白進(jìn)行免疫組化染色,。使用logistic回歸分析確認(rèn)術(shù)后譫妄的獨(dú)立預(yù)測因素,。
研究結(jié)果顯示：胃大部切除術(shù)后伴譫妄的患者和不伴譫妄的患者在年齡、性別,、手術(shù)時(shí)間或譫妄的初發(fā)情況沒有顯著差異,。術(shù)后譫妄患者較沒有出現(xiàn)譫妄的患者，重癥監(jiān)護(hù)室的住院率更高 (43.8 vs 6.3%, p = 0.037) ,，正常α核蛋白陽性病理機(jī)制 (56.3 vs 12.5%, p = 0.023) 和磷酸化α蛋白陽性病理機(jī)制(43.8 vs 6.3%, p = 0.037)均增高,。一項(xiàng)logistic回歸分析顯示：正常α核蛋白的免疫反應(yīng)性(優(yōu)勢比[OR] 9.20)和重癥監(jiān)護(hù)室住院率(OR 11.97)與術(shù)后譫妄獨(dú)立相關(guān)。
該研究發(fā)現(xiàn)：胃的潛在的α核蛋白病理機(jī)制與術(shù)后譫妄相關(guān),，提示術(shù)后譫妄是一種α核蛋白相關(guān)認(rèn)知障礙的臨床前期表現(xiàn),。 （生物谷Bioon.com）
doi: 10.1212/WNL.0b013e3182840782
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PMID:
α-Synuclein pathology is related to postoperative delirium in patients undergoing gastrectomy
Mun Kyung Sunwoo, MD,Jin Yong Hong, MD,Junjeong Choi, MD,Hyun Jung Park, PhD,Se Hoon Kim, MD* and Phil Hyu Lee, MD, PhD*
Objective: The clinical characteristics of postoperative delirium are similar to core features of α-synuclein–related cognitive disorders, such as dementia with Lewy bodies or Parkinson disease dementia. We therefore investigated the α-synuclein pathology in patients who experienced postoperative delirium after gastrectomy for stomach cancer.
Method: Patients with and without postoperative delirium were selected among patients undergoing total gastrectomy for primary gastric cancer from 2007 to 2011 (each n = 16) at the university hospital. Immunohistochemical staining for α-synuclein of both normal and phosphorylated form was performed in the myenteric plexus. A logistic regression analysis was applied to identify independent predictors of postoperative delirium.
Results: No significant differences were observed for age, sex, operation time, or onset of delirium after total gastrectomy between patients with and without postoperative delirium. Patients with postoperative delirium had a higher frequency of intensive care unit admissions (43.8 vs 6.3%, p = 0.037) and α-synuclein–positive pathologies of normal (56.3 vs 12.5%, p = 0.023) and phosphorylated form (43.8 vs 6.3%, p = 0.037) compared with those without postoperative delirium. A logistic regression analysis revealed that immunoreactivity for normal α-synuclein (odds ratio [OR] 9.20) and intensive care unit admission (OR 11.97) were independently associated with postoperative delirium.
Conclusion: These results suggest that underlying α-synuclein pathologies in the stomach are associated with postoperative delirium, implying that postoperative delirium represents a preclinical stage of α-synuclein related to cognitive disorders.
