探讨神经炎症及其在脊柱手术后认知功能障碍中的作用。

IF 3 3区医学 Q3 GERIATRICS & GERONTOLOGY

Gerontology Pub Date : 2025-10-20 DOI:10.1159/000548923

Johanna Ruhnau, Jonas Müller, Stephan Nowak, Sarah Strack, Denise Sperlich, Anna Pohl, Jasmin Dilz, Sebastian Rehberg, Taras Usichenko, Klaus Hahnenkamp, Martin Weidemeier, Johannes Ehler, Agnes Flöel, Henry W S Schroeder, Jan-Uwe Müller, Robert Fleischmann, Antje Vogelgesang

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引用次数: 0

摘要

背景：脊柱外科的进展显著提高了老年脊柱疾病患者手术的安全性。然而，术后认知功能障碍（POCD）仍然是一个值得关注的问题，因为它们与较差的预后和较高的长期护理风险有关。本研究旨在确定前神经炎症状态是否会加速神经退行性变，促进POCD的发展，并探讨特异性生物标志物是否可以预测POCD的风险。方法：纳入2018年2月至2020年3月期间计划进行择期脊柱手术的患者（年龄≥60岁）。术前和术后检测的生物标志物包括IL-6、CRP、S100钙结合蛋白β (S100β)、脑源性神经营养因子（BDNF）、神经丝轻链蛋白（sNFL）、Gasdermin D和髓样细胞2上表达的触发受体可溶性外结构域（sTREM2）。在基线和术后3个月使用CERAD测试组评估认知结果。结果：术后sTREM2和Gasdermin D水平与术后3个月的认知能力变化显著相关，尤其是记忆功能。较高的sTREM2水平与更大的认知能力下降相关，12个CERAD项目中有6个显示出负相关（例如，总体β = -0.010, p = 0.0003）。同样，术后较高的Gasdermin D水平与较差的表现有关，特别是在识别记忆方面（例如，单词列表识别β = -0.615, p = 0.032）。此外，较高的术前sNFL水平与多个领域较差的认知结果相关。结论：本研究强调了脊柱手术后神经炎症与认知能力下降之间的潜在关联。靶向神经炎症通路可能是减轻老年患者POCD的关键。生物标志物可能有助于识别高危患者，并指导有针对性的干预措施的发展。

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Exploring Neuroinflammation and Its Role in Postoperative Cognitive Dysfunction Following Spine Surgery.

: Background: Progress in spine surgery has significantly improved the safety of proce-dures for older patients with disabling spine disease. However, postoperative cognitive dysfunction (POCD) remain a concern due to their link with poorer outcomes and higher long-term care risk. This study aimed to determine if pro-neuroinflammatory states accelerate neurodegeneration, contributing to POCD development, and explore whether specific biomarkers could predict POCD risk.

Methods: Patients (aged ≥ 60 years) scheduled for elective spine surgery between February 2018 and March 2020 were enrolled. Biomarkers tested included IL-6, CRP, S100 calcium-binding protein β (S100β), Brain-derived neurotrophic factor (BDNF), Neurofilament light chain protein (sNFL), Gasdermin D, and soluble ectodomain of triggering receptor expressed on myeloid cells 2 (sTREM2), measured pre-operatively and postoperatively. Cognitive outcomes were assessed using the CERAD test battery at baseline and three months postoperatively.

Results: Postoperative levels of sTREM2 and Gasdermin D were significantly associated with cognitive performance changes three months after surgery, particularly in memory function. Higher sTREM2 levels were associated with greater cognitive decline, with six out of twelve CERAD items showing an inverse association (e.g., overall β = -0.010, p = 0.0003). Similarly, higher postoperative Gasdermin D levels were linked to worse performance, particularly in recognition memory (e.g., word list recognition β = -0.615, p = 0.032). Additionally, higher preoperative sNFL levels were associated with poorer cog-nitive outcomes across multiple domains.

Conclusions: This study highlights potential associations between neuroinflammation and cognitive decline following spine surgery. Targeting neuroin-flammatory pathways could be crucial in mitigating POCD in older patients. Biomarkers may help identify high-risk patients and guide the development of targeted interventions.

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来源期刊

Gerontology 医学-老年医学

CiteScore

6.00

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： In view of the ever-increasing fraction of elderly people, understanding the mechanisms of aging and age-related diseases has become a matter of urgent necessity. ''Gerontology'', the oldest journal in the field, responds to this need by drawing topical contributions from multiple disciplines to support the fundamental goals of extending active life and enhancing its quality. The range of papers is classified into four sections. In the Clinical Section, the aetiology, pathogenesis, prevention and treatment of agerelated diseases are discussed from a gerontological rather than a geriatric viewpoint. The Experimental Section contains up-to-date contributions from basic gerontological research. Papers dealing with behavioural development and related topics are placed in the Behavioural Science Section. Basic aspects of regeneration in different experimental biological systems as well as in the context of medical applications are dealt with in a special section that also contains information on technological advances for the elderly. Providing a primary source of high-quality papers covering all aspects of aging in humans and animals, ''Gerontology'' serves as an ideal information tool for all readers interested in the topic of aging from a broad perspective.