用于阿尔茨海默病的脑脊液生物标志物可预测术后认知功能障碍。

Cerebrospinal Fluid Biomarker for Alzheimer Disease Predicts Postoperative Cognitive Dysfunction.

作者信息

Evered Lisbeth, Silbert Brendan, Scott David A, Ames David, Maruff Paul, Blennow Kaj

机构信息

From the Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, and Anaesthesia, Perioperative, and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia (L.E., B.S., D.A.S.); Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, and National Ageing Research Institute, Parkville, Victoria, Australia (D.A.); Florey Institute for Neuroscience and Mental Health, Parkville, Victoria, Australia (P.M.); and Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Gothenburg, Sweden (K.B.).

出版信息

Anesthesiology. 2016 Feb;124(2):353-61. doi: 10.1097/ALN.0000000000000953.

DOI:10.1097/ALN.0000000000000953

PMID:26580833

Abstract

BACKGROUND

Postoperative cognitive dysfunction (POCD) affects 16 to 21% of the elderly 3 months after anesthesia and surgery and is associated with adverse outcomes. The exact cause of POCD remains unknown. The authors hypothesized that elderly individuals with Alzheimer disease (AD) neuropathology, identified by cerebrospinal fluid (CSF) analysis, would have increased the risk for POCD.

METHODS

CSF samples were collected from 59 patients 60 yr or older who received combined spinal and general anesthesia for elective total hip replacement. Patients underwent neuropsychological testing preoperatively and at 7 days, 3 months, and 12 months postoperatively. POCD at 3 months and cognitive decline at 12 months were calculated by using the reliable change index. CSF amyloid β1-42 (Aβ1-42), total-tau, phosphorylated-tau, and neurofilament light were assayed with enzyme-linked immunosorbent assay methods.

RESULTS

POCD was identified in 5 of 57 patients (8.8%) at 3 months. For Aβ1-42, 11 patients were below the cut-point for AD neuropathology of whom 3 were classified with POCD (27.3%; 95% CI, 6.0 to 61%), whereas of the 46 patients above the cut-point, 2 were classified with POCD (4.3%; 95% CI, 0.5 to 14.8%) (P = 0.01). There was no significant difference in the incidence of POCD in relation to the cut-points for any of the other analytes.

CONCLUSIONS

Low CSF Aβ1-42 may be a significant predictor of POCD at 3 months. This indicates that patients with AD neuropathology even in the absence of clinically detectable AD symptoms may be susceptible to POCD.

摘要

背景

术后认知功能障碍（POCD）在麻醉和手术后3个月影响16%至21%的老年人，并与不良后果相关。POCD的确切病因尚不清楚。作者推测，通过脑脊液（CSF）分析确定患有阿尔茨海默病（AD）神经病理学的老年人患POCD的风险会增加。

方法

收集59例60岁及以上接受腰麻联合全麻择期全髋关节置换术患者的脑脊液样本。患者在术前以及术后7天、3个月和12个月接受神经心理学测试。使用可靠变化指数计算3个月时的POCD和12个月时的认知衰退。采用酶联免疫吸附测定法检测脑脊液淀粉样β1-42（Aβ1-42）、总tau蛋白、磷酸化tau蛋白和神经丝轻链。

结果

57例患者中有5例（8.8%）在3个月时被诊断为POCD。对于Aβ1-42，11例患者低于AD神经病理学的切点，其中3例被归类为POCD（27.3%；95%CI，6.0至61%），而在46例高于切点的患者中，2例被归类为POCD（4.3%；95%CI，0.5至14.8%）（P = 0.01）。与任何其他分析物的切点相关的POCD发生率没有显著差异。