免疫组化下的α核蛋白（A图箭头所指为正常型，B图箭头所指为磷酸化型）
术后谵妄的临床特性与α核蛋白相关认知障碍（如路易体痴呆和帕金森病痴呆）的核心特征相关。胃癌患者胃切除术后谵妄的α核蛋白病理机制尚不明确。为此，韩国延世医学院神经科的Mun Kyung Sunwoo博士等人进行了一项研究，研究结果在线发表在2013年1月30日的Neurology杂志上。研究结果发现：胃的潜在的α核蛋白病理机制与术后谵妄相关，提示术后谵妄是一种α核蛋白相关认知障碍的临床前期表现。
研究人员从大学医院2007-2011年因原发性胃癌行胃大部切除术的患者中选择出现和没有出现谵妄的患者。对肌间神经丛中正常和磷酸化形式的α核蛋白进行免疫组化染色。使用logistic回归分析确认术后谵妄的独立预测因素。
研究结果显示：胃大部切除术后伴谵妄的患者和不伴谵妄的患者在年龄、性别、手术时间或谵妄的初发情况没有显著差异。术后谵妄患者较没有出现谵妄的患者，重症监护室的住院率更高 (43.8 vs 6.3%, p = 0.037) ，正常α核蛋白阳性病理机制 (56.3 vs 12.5%, p = 0.023) 和磷酸化α蛋白阳性病理机制(43.8 vs 6.3%, p = 0.037)均增高。一项logistic回归分析显示：正常α核蛋白的免疫反应性(优势比[OR] 9.20)和重症监护室住院率(OR 11.97)与术后谵妄独立相关。
该研究发现：胃的潜在的α核蛋白病理机制与术后谵妄相关，提示术后谵妄是一种α核蛋白相关认知障碍的临床前期表现。 （生物谷Bioon.com）
doi: 10.1212/WNL.0b013e3182840782
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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.
