胆囊切除术后POCD的预测因素：肠-脑轴紊乱、肠屏障损伤和全身炎症：一项巢式病例对照研究
Gut-brain axis disruption, intestinal barrier damage, and systemic inflammation as predictors of POCD after cholecystectomy: a nested case-control study.
摘要(中文译文)
术后认知功能障碍（POCD）是胆囊切除术后常见的并发症，其完整发病机制仍涉及多种因素。越来越多的证据表明，肠-脑轴在POCD的发生发展中起关键作用，但肠屏障功能障碍、全身性炎症与认知损害之间的具体关系尚未在胆囊切除术患者中进行定量刻画。本前瞻性巢式病例对照研究连续纳入361例择期胆囊切除术患者。采用可靠变化指数（RCI）识别POCD患者。将24例POCD患者与48例非POCD对照按1:2进行匹配。检测血清脂多糖结合蛋白（LBP）、白细胞介素-6（IL-6）、TNF-α及神经元损伤标志物水平。24例（6.7%）发生POCD。基线特征均衡良好。POCD患者表现出肠-脑轴生物标志物失调以及更明显、更持久的术后炎症反应。多因素回归分析确定术后LBP（每升高1 μg/mL；aOR = 1.08，95%CI = 1.03-1.13，= 0.001）、术后IL-6峰值（每升高1 pg/mL；aOR = 1.02，95%CI = 1.01-1.03，< 0.001）及术后TNF-α峰值为POCD的独立危险因素。较高的术前MMSE评分为保护因素（aOR = 0.85，95%CI = 0.73-0.99，= 0.038）。ΔMMSE下降幅度越大与POCD风险增加相关。本研究证实，肠漏、全身性炎症与胆囊切除术后POCD之间存在稳定且独立的关联。LBP和IL-6是该通路中的关键生物标志物，对POCD风险具有较高的预测价值。肠-脑轴驱动术后神经炎症，从而支持针对POCD预防和治疗的靶向策略。
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication following cholecystectomy, and the full pathogenesis remains multifactorial. Accumulating evidence suggests that the gut-brain axis plays a critical role in the development of POCD, but the specific relationship linking intestinal barrier dysfunction, systemic inflammation, and cognitive impairment has not been quantitatively characterized in cholecystectomy patients. This prospective nested case-control study enrolled 361 consecutive patients scheduled for elective cholecystectomy. Patients with POCD were identified using the Reliable Change Index (RCI). 24 POCD patients were matched 1:2 with 48 non-POCD controls. Serum levels of lipopolysaccharide-binding protein (LBP), interleukin-6 (IL-6), TNF-α, and neuronal injury markers were detected. 24 (6.7%) developed POCD. Baseline characteristics were well balanced. POCD patients exhibited dysregulated gut-brain axis biomarkers and a more pronounced, sustained postoperative inflammatory response. Multivariate regression analysis identified postoperative LBP (per 1 μg/mL increase; aOR = 1.08, 95%CI = 1.03-1.13, = 0.001), peak postoperative IL-6 (per 1 pg/mL increase; aOR = 1.02, 95%CI = 1.01-1.03, < 0.001), and peak postoperative TNF-α as independent risk factors for POCD. Higher preoperative MMSE score was a protective factor (aOR = 0.85, 95%CI = 0.73-0.99, = 0.038). A greater decline in ΔMMSE was associated with an increased POCD risk. This study confirms a stable and independent association between intestinal leakage, systemic inflammation, and POCD following cholecystectomy. LBP and IL-6 are key biomarkers in this pathway, with high predictive value for POCD risk. The gut-brain axis drives postoperative neuroinflammation, thus supporting targeted strategies for the prevention and treatment of POCD.
如何引用
AMA
Yanlong Fu, Qiang Wei, Huiru Chen, Xiaoyun Wu, Menghan Li, Wenxin Shi. Gut-brain axis disruption, intestinal barrier damage, and systemic inflammation as predictors of POCD after cholecystectomy: a nested case-control study.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1833830.
APA
Yanlong Fu, Qiang Wei, Huiru Chen, Xiaoyun Wu, Menghan Li, Wenxin Shi (2026). Gut-brain axis disruption, intestinal barrier damage, and systemic inflammation as predictors of POCD after cholecystectomy: a nested case-control study.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1833830
GB/T 7714
Yanlong Fu, Qiang Wei, Huiru Chen, Xiaoyun Wu, Menghan Li, Wenxin Shi. Gut-brain axis disruption, intestinal barrier damage, and systemic inflammation as predictors of POCD after cholecystectomy: a nested case-control study.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1833830.
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