CAJ | 학술논문

目的：研究围手术期脑源性神经营养因子（ BDNF）的单核苷酸多态性及其表达与术后认知功能障碍（ POCD）的关系。方法结核病手术患者223例术前均行 PET 检测和认知功能测定。其中20例诊断为 POCD者，在治疗后第3天、1个月、3个月分别行 PET 检测，并进行 BDNF基因 SNP的检测和基因型分析。结果①2-back 任务中，BDNF Val纯合子组比 BDNF Met携带者表现差。②BDNF Val纯合子组休息局部脑血流量（ rCBF）有更低的基底海马 rCBF。③基因型主要作用在几个中线区域，包括中央前回和几个扣带皮质集群以及杏仁核和左颞下叶和中央后回，海马 rCBF 在 BDNF Met携带组呈强阳性，但不在 Val纯合子表现。相反的，在中间枕骨和上颞脑回，海马 rCBFVal纯合子表现出强阳性，BDNF Met 携带组不表现。④海马 rCBF明显影响平均海马工作记忆激活，BDNF Met携带组中更明显。⑤在 BDNF Val纯合子组，海马失活强烈预测横向 PFC激活和前和后扣带皮质失活。结论 POCD 者大脑功能发生变化，在分子水平上也反映大脑存在生理或病理变化。
목적：연구위수술기뇌원성신경영양인자（ BDNF）적단핵감산다태성급기표체여술후인지공능장애（ POCD）적관계。방법결핵병수술환자223례술전균행 PET 검측화인지공능측정。기중20례진단위 POCD자，재치료후제3천、1개월、3개월분별행 PET 검측，병진행 BDNF기인 SNP적검측화기인형분석。결과①2-back 임무중，BDNF Val순합자조비 BDNF Met휴대자표현차。②BDNF Val순합자조휴식국부뇌혈류량（ rCBF）유경저적기저해마 rCBF。③기인형주요작용재궤개중선구역，포괄중앙전회화궤개구대피질집군이급행인핵화좌섭하협화중앙후회，해마 rCBF 재 BDNF Met휴대조정강양성，단불재 Val순합자표현。상반적，재중간침골화상섭뇌회，해마 rCBFVal순합자표현출강양성，BDNF Met 휴대조불표현。④해마 rCBF명현영향평균해마공작기억격활，BDNF Met휴대조중경명현。⑤재 BDNF Val순합자조，해마실활강렬예측횡향 PFC격활화전화후구대피질실활。결론 POCD 자대뇌공능발생변화，재분자수평상야반영대뇌존재생리혹병리변화。
Objective It is to study the relationship of single nucleotide polymorphism of brain-derived neurotmphic factor ( BDNF)and and its expression with postoperative cognitive dysfunction during perioperative period. Methods 223 cases of tu-berculosis patients undergoing surgery were given PET detection and cognitive function evaluation before operation,of which there were 20 cases diagnozed as POCD,who were given PET detection again in 3days,one month and 3 months after treat-ment,at the same time SNP of BDNF gene were detected and the gene type was analyzed. Results In 2 -back mission,BDNF Val homozygote group did worse than BDNF Met carriers. rCBF of BDNF Val homozygote group had lower rCBF in hippocam-pus and basilar. Gene type mainly played a part in several central line part,including precentral gyrus,several cingulate cor-tex cluster and amygdala,left inferotemporal cortex and postcentral gyrus. Hippocampus rCBF was strong positive in BDNF Met carrier group,but negative in BDNF Val homozygote group,rather,in middle occipital bone and superior temporal gyrus, the expression was strong positive in Val homozygote group,but negative in BDNF Met carrier group. Hippocampus rCBF obvi-ously influence average hippocampus work memory activity,especially more obvious in BDNF Met carrier group. In BDNF Val homozygote group,hippocampus inactivation strongly indicated transverse PFC activation and front and back cingulate cortex inactivation. Conclusion Cerebral function changed in POCD patients,at molecular level,this could also indicate that there were physiological or pathological changes in brain.