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肠道菌群参与术后认知功能障碍发病的研究进展
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Abstract:
术后认知功能障碍(Postoperative Cognitive Dysfunction, POCD)是外科手术常见并发症之一，好发于老年骨科手术患者，尤其是老年髋部骨折患者。近年来研究发现，术后认知功能障碍患者存在明显的肠道菌群紊乱，提示肠道菌群在POCD发生发展中发挥重要作用。本文基于目前的有关基础实验及临床研究，对肠道菌群参与术后认知功能障碍发生发展途径及机制进行综述，以望对其科学研究和临床治疗提供新思路。
Postoperative cognitive dysfunction (POCD) is one of the common complications of surgery. It often occurs in elderly orthopaedic patients, especially elderly patients with hip fracture. Recent studies have found that patients with postoperative cognitive dysfunction have obvious intestinal flora disorder, suggesting that gut microbiota plays an important role in the occurrence and de-velopment of POCD. Based on the current basic experimental and clinical research, this paper summarizes the ways and mechanisms of gut microbiota involved in the occurrence and develop-ment of postoperative cognitive dysfunction, in order to provide new ideas for its scientific research and clinical treatment.
| [1] | Uzoigwe, C.E., O’Leary, L., Nduka, J., et al. (2020) Factors Associated with Delirium and Cognitive Decline Following Hip Fracture Surgery. The Bone & Joint Journal, 102-B, 1675-1681.
https://doi.org/10.1302/0301-620X.102B12.BJJ-2019-1537.R3 |
| [2] | MacLullich, A.M. and Hall, R.J. (2011) Who Understands Delirium? Age and Ageing, 40, 412-414.
https://doi.org/10.1093/ageing/afr062 |
| [3] | Naeije, G. and Pepersack, T. (2014) Delirium in Elderly People. The Lancet (London, England), 383, 2044-2045.
https://doi.org/10.1016/S0140-6736(14)60993-4 |
| [4] | Gleason, L.J., Schmitt, E.M., Kosar, C.M., et al. (2015) Ef-fect of Delirium and Other Major Complications on Outcomes after Elective Surgery in Older Adults. JAMA Surgery, 150, 1134-1140.
https://doi.org/10.1001/jamasurg.2015.2606 |
| [5] | Jones, R.N., Cizginer, S., Pavlech, L., et al. (2019) Assessment of Instruments for Measurement of Delirium Severity: A Systematic Review. JAMA Internal Medicine, 179, 231-239. https://doi.org/10.1001/jamainternmed.2018.6975 |
| [6] | Heintz-Buschart, A. and Wilmes, P. (2018) Human Gut Microbiome: Function Matters. Trends in Microbiology, 26, 563-574. https://doi.org/10.1016/j.tim.2017.11.002 |
| [7] | Morais, L.H., Schreiber, H.L. and Mazmanian, S.K. (2021) The Gut Microbiota-Brain Axis in Behaviour and Brain Disorders. Nature Reviews Microbiology, 19, 241-255. https://doi.org/10.1038/s41579-020-00460-0 |
| [8] | Zhan, G., Yang, N., Li, S., et al. (2018) Abnormal Gut Microbiota Composition Contributes to Cognitive Dysfunction in SAMP8 Mice. Aging, 10, 1257-1267. https://doi.org/10.18632/aging.101464 |
| [9] | Li, Q., Han, Y., Dy, A.B.C., et al. (2017) The Gut Microbiota and Autism Spectrum Disorders. Frontiers in Cellular Neuroscience, 11, Article No. 120. https://doi.org/10.3389/fncel.2017.00120 |
| [10] | Lv, F., Chen, S., Wang, L., et al. (2017) The Role of Microbiota in the Pathogenesis of Schizophrenia and Major Depressive Disorder and the Possibility of Targeting Microbiota as A Treatment Option. Oncotarget, 8, 100899-100907.
https://doi.org/10.18632/oncotarget.21284 |
| [11] | Yang, C., Qu, Y., Fujita, Y., et al. (2017) Possible Role of the Gut Microbiota-Brain Axis in the Antidepressant Effects of (R)-ketamine in a Social Defeat Stress Model. Translational Psychiatry, 7, 1294.
https://doi.org/10.1038/s41398-017-0031-4 |
| [12] | Jiang, X.L., Gu, X.Y., Zhou, X.X., et al. (2019) Intestinal Dysbacteriosis Mediates the Reference Memory Deficit Induced by Anaesthesia/Surgery in Aged Mice. Brain, Behavior, and Immunity, 80, 605-615.
https://doi.org/10.1016/j.bbi.2019.05.006 |
| [13] | Zhan, G., Hua, D., Huang, N., et al. (2019) Anesthesia and Surgery Induce Cognitive Dysfunction in Elderly Male Mice: The Role of Gut Microbiota. Aging, 11, 1778-1790. https://doi.org/10.18632/aging.101871 |
| [14] | Moller, J.T., Cluitmans, P., Rasmussen, L.S., et al. (1998) Long-Term Postoperative Cognitive Dysfunction in the Elderly ISPOCD1 Study. ISPOCD Investigators. International Study of Post-Operative Cognitive Dysfunction. The Lancet (London, England), 351, 857-861. https://doi.org/10.1016/S0140-6736(97)07382-0 |
| [15] | Jeffery, I.B., Lynch, D.B. and O’Toole, P.W. (2016) Com-position and Temporal Stability of the Gut Microbiota in Older Persons. The ISME Journal, 10, 170-182. https://doi.org/10.1038/ismej.2015.88 |
| [16] | Claesson, M.J., Jeffery, I.B., Conde, S., et al. (2012) Gut Microbiota Composition Correlates with Diet and Health in the Elderly. Nature, 488, 178-184. https://doi.org/10.1038/nature11319 |
| [17] | Lee, J., Venna, V.R., Durgan, D.J., et al. (2020) Young versus Aged Microbiota Transplants to Germ-Free Mice: Increased Short-Chain Fatty Acids and Improved Cognitive Performance. Gut Microbes, 12, 1-14.
https://doi.org/10.1080/19490976.2020.1814107 |
| [18] | D’Amato, A., Di Cesare Mannelli, L., Lucarini, E., et al. (2020) Faecal Microbiota Transplant from Aged Donor Mice Affects Spatial Learning and Memory via Modulating Hippocampal Synaptic Plasticity- and Neurotransmission-Related Proteins in Young Recipients. Microbiome, 8, 140. https://doi.org/10.1186/s40168-020-00914-w |
| [19] | Feinkohl, I., Winterer, G. and Pischon, T. (2017) Diabetes Is Associated with Risk of Postoperative Cognitive Dysfunction: A Meta-Analysis. Diabetes/Metabolism Research and Reviews, 33, e2884. https://doi.org/10.1002/dmrr.2884 |
| [20] | Kadoi, Y., Saito, S., Fujita, N., et al. (2005) Risk Factors for Cognitive Dysfunction after Coronary Artery Bypass Graft Surgery in Patients with Type 2 Diabetes. The Journal of Thoracic and Cardiovascular Surgery, 129, 576-583.
https://doi.org/10.1016/j.jtcvs.2004.07.012 |
| [21] | Larsen, N., Vogensen, F.K., van den Berg, F.W., et al. (2010) Gut Microbiota in Human Adults with Type 2 Diabetes Differs from Non-Diabetic Adults. PLoS ONE, 5, e9085. https://doi.org/10.1371/journal.pone.0009085 |
| [22] | Wu, X., Ma, C., Han, L., et al. (2010) Molecular Characterisa-tion of the Faecal Microbiota in Patients with Type II Diabetes. Current Microbiology, 61, 69-78. https://doi.org/10.1007/s00284-010-9582-9 |
| [23] | Kim, Y.A., Keogh, J.B. and Clifton, P.M. (2018) Probiotics, Prebiotics, Synbiotics and Insulin Sensitivity. Nutrition Research Reviews, 31, 35-51. https://doi.org/10.1017/S095442241700018X |
| [24] | Zhao, L., Zhang, F., Ding, X., et al. (2018) Gut Bacteria Se-lectively Promoted by Dietary Fibers Alleviate Type 2 Diabetes. Science (New York, NY), 359, 1151-1156. https://doi.org/10.1126/science.aao5774 |
| [25] | Moghadamrad, S., McCoy, K.D., Geuking, M.B., et al. (2015) At-tenuated Portal Hypertension in Germ-Free Mice: Function of Bacterial Flora on the Development of Mesenteric Lymphatic and Blood Vessels. Hepatology (Baltimore, Md), 61, 1685-1695. https://doi.org/10.1002/hep.27698 |
| [26] | Yang, T., Santisteban, M.M., Rodriguez, V., et al. (2015) Gut Dysbiosis Is Linked to Hypertension. Hypertension (Dallas, Tex: 1979), 65, 1331-1340. https://doi.org/10.1161/HYPERTENSIONAHA.115.05315 |
| [27] | Khalesi, S., Sun, J., Buys, N., et al. (2014) Effect of Probiotics on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials. Hyper-tension (Dallas, Tex: 1979), 64, 897-903.
https://doi.org/10.1161/HYPERTENSIONAHA.114.03469 |
| [28] | Gómez-Guzmán, M., Toral, M., Romero, M., et al. (2015) Antihypertensive Effects of Probiotics Lactobacillus Strains in Spontaneously Hypertensive Rats. Molecular Nutrition & Food Research, 59, 2326-2336.
https://doi.org/10.1002/mnfr.201500290 |
| [29] | Zhang, J., Bi, J.J., Guo, G.J., et al. (2019) Abnormal Composition of Gut Microbiota Contributes to Delirium-Like Behaviors after Abdominal Surgery in Mice. CNS Neuroscience & Therapeutics, 25, 685-696.
https://doi.org/10.1111/cns.13103 |
| [30] | Skvarc, D.R., Berk, M., Byrne, L.K., et al. (2018) Post-Operative Cognitive Dysfunction: An Exploration of the Inflammatory Hypothesis and Novel Therapies. Neuroscience and Biobehavioral Reviews, 84, 116-133.
https://doi.org/10.1016/j.neubiorev.2017.11.011 |
| [31] | Barrientos, R.M., Hein, A.M., Frank, M.G., et al. (2012) Intracisternal Interleukin-1 Receptor Antagonist Prevents Postoperative Cognitive Decline and Neuroinflammatory Response in Aged Rats. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 32, 14641-14648. https://doi.org/10.1523/JNEUROSCI.2173-12.2012 |
| [32] | Qiu, L.L., Ji, M.H., Zhang, H., et al. (2016) NADPH Oxidase 2-Derived Reactive Oxygen Species in the Hippocampus Might Contribute to Microglial Activation in Postoperative Cognitive Dysfunction in Aged Mice. Brain, Behavior, and Immunity, 51, 109-118. https://doi.org/10.1016/j.bbi.2015.08.002 |
| [33] | Beloosesky, Y., Hendel, D., Weiss, A., et al. (2007) Cytokines and C-Reactive Protein Production in Hip-Fracture-Operated Elderly Patients. The Journals of Gerontology Series A, Bio-logical Sciences and Medical Sciences, 62, 420-426.
https://doi.org/10.1093/gerona/62.4.420 |
| [34] | Buvanendran, A., Kroin, J.S., Berger, R.A., et al. (2006) Upregulation of Prostaglandin E2 and Interleukins in the Central Nervous System and Peripheral Tissue during and after Surgery in Humans. Anesthesiology, 104, 403-410.
https://doi.org/10.1097/00000542-200603000-00005 |
| [35] | Safavynia, S.A. and Goldstein, P.A. (2018) The Role of Neuroinflammation in Postoperative Cognitive Dysfunction: Moving from Hypothesis to Treatment. Frontiers in Psychiatry, 9, Article No. 752.
https://doi.org/10.3389/fpsyt.2018.00752 |
| [36] | Lukiw, W.J. (2016) Bacteroides Fragilis Lipopolysaccharide and Inflammatory Signaling in Alzheimer’s Disease. Frontiers in Microbiology, 7, Article No. 1544. https://doi.org/10.3389/fmicb.2016.01544 |
| [37] | de La Serre, C.B., de Lartigue, G. and Raybould, H.E. (2015) Chronic Exposure to Low Dose Bacterial Lipopolysaccharide Inhibits Leptin Signaling in Vagal Afferent Neurons. Physiology & Behavior, 139, 188-194.
https://doi.org/10.1016/j.physbeh.2014.10.032 |
| [38] | Meng, F., Li, N., Li, D., et al. (2019) The Presence of Elevated Circulating Trimethylamine N-Oxide Exaggerates Postoperative Cognitive Dysfunction in Aged Rats. Behavioural Brain Research, 368, Article ID: 111902.
https://doi.org/10.1016/j.bbr.2019.111902 |
| [39] | Obermeier, B., Daneman, R. and Ransohoff, R.M. (2013) Devel-opment, Maintenance and Disruption of the Blood-Brain Barrier. Nature Medicine, 19, 1584-1596. https://doi.org/10.1038/nm.3407 |
| [40] | Zhu, S., Jiang, Y., Xu, K., et al. (2020) The Progress of Gut Microbiome Research Related to Brain Disorders. Journal of Neuroinflammation, 17, 25. https://doi.org/10.1186/s12974-020-1705-z |
| [41] | Wu, S.C., Cao, Z.S., Chang, K.M., et al. (2017) Intestinal Mi-crobial Dysbiosis Aggravates the Progression of Alzheimer’s Disease in Drosophila. Nature Communications, 8, Article No. 24. https://doi.org/10.1038/s41467-017-00040-6 |
| [42] | Braniste, V., Al-Asmakh, M., Kowal, C., et al. (2014) The Gut Microbiota Influences Blood-Brain Barrier Permeability in Mice. Science Translational Medicine, 6, 263ra158. https://doi.org/10.1126/scitranslmed.3009759 |
| [43] | Zhang, J., Zhu, S., Jin, P., et al. (2020) Graphene Oxide Improves Postoperative Cognitive Dysfunction by Maximally Alleviating Amyloid Beta Burden in Mice. Theranostics, 10, 11908-11920. https://doi.org/10.7150/thno.50616 |
| [44] | Huang, C., Chu, J.M., Liu, Y., et al. (2018) Varenicline Reduces DNA Damage, Tau Mislocalization and Post Surgical Cognitive Impairment in Aged Mice. Neuropharmacology, 143, 217-227.
https://doi.org/10.1016/j.neuropharm.2018.09.044 |
| [45] | Li, Y., Yuan, Y., Li, Y., et al. (2021) α Inhibition of -Synuclein Accumulation Improves Neuronal Apoptosis and Delayed Postoperative Cognitive Recovery in Aged Mice. Oxidative Medicine and Cellular Longevity, 2021, Article ID: 5572899. https://doi.org/10.1155/2021/5572899 |
| [46] | Hill, J.M. and Lukiw, W.J. (2015) Microbial-Generated Amyloids and Alzheimer’s Disease (AD). Frontiers in Aging Neuroscience, 7, Article No. 9. https://doi.org/10.3389/fnagi.2015.00009 |
| [47] | Mao, L., Zeng, Q., Su, W., et al. (2021) Elevation of miR-146a In-hibits BTG2/BAX Expression to Ameliorate Postoperative Cognitive Dysfunction Following Probiotics (VSL#3) Treatment. Molecular Neurobiology, 58, 3457-3470.
https://doi.org/10.1007/s12035-021-02330-z |
| [48] | Wang, P., Yin, X., Chen, G., et al. (2021) Perioperative Probiotic Treatment Decreased the Incidence of Postoperative Cognitive Impairment in Elderly Patients Following Non-Cardiac Surgery: A Randomised Double-Blind and Placebo-Controlled Trial. Clinical Nutrition (Edinburgh, Scotland), 40, 64-71. https://doi.org/10.1016/j.clnu.2020.05.001 |
| [49] | Han, D., Li, Z., Liu, T., et al. (2020) Prebiotics Regulation of Intestinal Microbiota Attenuates Cognitive Dysfunction Induced by Surgery Stimulation in APP/PS1 Mice. Aging and Disease, 11, 1029-1045.
https://doi.org/10.14336/AD.2020.0106 |
