Effect of Dexmedetomidine on Postoperative Cognitive Dysfunction and the T Helper 17/regulatory T Cell Balance in Geriatric Patients Undergoing Orthopedic Surgery: a Randomized Controlled Study

Overview

Journal Am J Transl Res

Specialty General Medicine

Date 2023 May 16

PMID 37193172

Authors

Weihong Zhao

Jianli Li

Jing Wang

Meinv Liu

Dongdong Yu

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate the effect of dexmedetomidine (DEX) on alleviating postoperative cognitive dysfunction (POCD) and T helper 17 (Th17)/regulatory T cell (Treg) imbalance in geriatric patients undergoing orthopedic surgery.

Methods: A total of 82 geriatric patients undergoing lower extremity joint replacement surgery were enrolled and randomized into two groups. Patients in the experimental group received a loading dose of 0.5 µg/kg DEX for 10 min and then a maintenance dose of 0.5 µg/kg/h DEX until 30 min before the end of the surgery, while patients in the control group were administered with an equal volume of saline. The mini-mental state examination (MMSE) was used to evaluate the patients' cognitive function levels. The enzyme-linked immunosorbent assay (ELISA) was used to detect the protein levels of S100 calcium-binding protein B (S-100β), matrix metalloproteinase 9 (MMP9), interleukin-10 (IL-10) and interleukin-17A (IL-17A). The quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect and compare the mRNA levels of retinoic acid-related orphan receptor gamma-t (RORγt) and forkhead box P3 (Foxp3), the ratio of which reflected Th17/Treg balance.

Results: Compared to the control group, the MMSE scores in the DEX group were obviously higher at 24 and 72 h after the surgery, and the incidence of POCD was lower in the DEX group. Simultaneously, DEX significantly decreased the level of S100β, MMP9, and the ratio of RORγt/Foxp3 mRNA at the end of the surgery and one day after surgery. Furthermore, IL-10 was upregulated, while the IL-17A and the IL-17A/IL-10 ratio were downregulated at the end of the surgery and one day after surgery in the DEX group.

Conclusions: DEX could reduce the incidence of POCD in elderly orthopedic patients, which might be related to the attenuation of inflammatory response and blood-brain barrier (BBB) damage through modulating the Th17/Treg imbalance.

Citing Articles

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