Zhang X, Fu Q
Department of Anesthesiology, General Hospital of PLA, Beijing 100853, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Apr 20;41(4):574-578. doi: 10.12122/j.issn.1673-4254.2021.04.14.
To detect cerebrospinal fluid levels of amyloid beta- protein 42 (Aβ42) and neurofilament light protein (NFL) and explore their correlation with postoperative neurocognitive dysfunction (PNCD) in elderly patients.
A total of 90 elderly patients undergoing hip or knee replacement with joint epidural anesthesia in our Hospital between January, 2017 and December, 2018 were recruited in this study. The levels of Aβ42 and NFL in the cerebrospinal fluid were detected using ELISA. Simple cognitive status assessment scale (MMSE) was used to evaluate the cognitive status of the patients 1 day before and 7 days after the surgery. All the patients underwent neurocognitive function tests, and the z-score method was used to determine the occurrence of PNCD. Spearman rank correlation analysis was used to analyze the correlation of Aβ42 and NFL levels in the cerebrospinal fluid with MMSE scores. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of cerebrospinal fluid Aβ42 and NFL levels for PNCD.
PNCD occurred in 38 of the 90 elderly patients, with an incidence of 42.2%. The level of Aβ42 in the cerebrospinal fluid was significantly lower in PNCD group than in the nonPNCD group (1.96 vs 2.54 ng/mL; =3.29, < 0.05); the concentration of NFL in the cerebrospinal fluid was significantly higher in PNCD group than in non- PNCD group (4.59 vs 3.16 ng/mL; =3.72, < 0.05). Aβ42 level in the cerebrospinal fluid was positively correlated while NFL was negatively correlated with the MMSE score of the patients (=-0.659, < 0.05; =-0.626, < 0.05). ROC curve analysis showed that the area under the curve (AUC) of cerebrospinal fluid Aβ42 and NFL levels were 0.744 and 0.768, respectively; the AUC of their combination was 0.847 for prediction of PNCD.
Elderly patients with PNCD have significantly higher levels of Aβ42 and NFL in the cerebrospinal fluid than those without PNCD. Both Aβ42 and NFL levels in the cerebrospinal fluid can help to predict the occurrence of POCD in elderly patients, and their combination has a higher diagnostic value.
检测老年患者脑脊液中β淀粉样蛋白42（Aβ42）和神经丝轻链蛋白（NFL）水平，并探讨其与术后认知功能障碍（PNCD）的相关性。
选取2017年1月至2018年12月在我院行髋关节或膝关节置换术并采用关节硬膜外麻醉的90例老年患者纳入本研究。采用酶联免疫吸附测定法（ELISA）检测脑脊液中Aβ42和NFL水平。采用简易认知状态评估量表（MMSE）评估患者术前1天和术后7天的认知状态。所有患者均接受神经认知功能测试，采用z评分法确定PNCD的发生情况。采用Spearman等级相关分析脑脊液中Aβ42和NFL水平与MMSE评分的相关性。采用受试者工作特征曲线（ROC）分析脑脊液Aβ42和NFL水平对PNCD的预测价值。
90例老年患者中38例发生PNCD，发生率为42.2%。PNCD组脑脊液中Aβ42水平显著低于非PNCD组（1.96 vs 2.54 ng/mL；t=3.29，P<0.05）；PNCD组脑脊液中NFL浓度显著高于非PNCD组（4.59 vs 3.16 ng/mL；t=3.72，P<0.05）。脑脊液中Aβ42水平与患者MMSE评分呈正相关，而NFL与患者MMSE评分呈负相关（r=-0.659，P<0.05；r=-0.626，P<0.05）。ROC曲线分析显示，脑脊液Aβ42和NFL水平的曲线下面积（AUC）分别为0.744和0.768；二者联合预测PNCD的AUC为0.847。
发生PNCD的老年患者脑脊液中Aβ42和NFL水平显著高于未发生PNCD的患者。脑脊液中Aβ42和NFL水平均有助于预测老年患者POCD的发生，二者联合具有更高的诊断价值。
