Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2023 Jul 31;14:1212815. doi: 10.3389/fendo.2023.1212815. eCollection 2023.
This study aimed to identify preoperative blood biomarkers related to development of delayed neurocognitive recovery (dNCR) following surgery.
A total of 67 patients (≥65 years old) who underwent head and neck tumor resection under general anesthesia were assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Preoperative serum metabolomics were determined using widely targeted metabolomics technology.
Of the 67 patients, 25 developed dNCR and were matched to 25 randomly selected patients from the remaining 42 without dNCR. Differential metabolites were selected using the criteria of variable importance in projection > 1.0 in orthogonal partial least squares discrimination analysis, false discovery rate <0.05, and fold-change >1.2 or <0.83 to minimize false positives. Preoperative serum levels of oxaloacetate (OR: 1.054, 95% CI: 1.027-1.095, = 0.001) and 2-aminoadipic acid (2-AAA) (OR: 1.181, 95% CI: 1.087-1.334, = 0.001) were associated with postoperative dNCR after adjusting for anesthesia duration, education, and age. Areas under the curve for oxaloacetate and 2-AAA were 0.86 (sensitivity: 0.84, specificity: 0.88) and 0.86 (sensitivity: 0.84, specificity: 0.84), respectively. High levels of preoperative oxaloacetate and 2-AAA also were associated with postoperative decreased MoCA (β: 0.022, 95% CI: 0.005-0.04, = 0.013 for oxaloacetate; β: 0.077, 95%CI: 0.016-0.137, = 0.014 for 2-AAA) and MMSE (β: 0.024, 95% CI: 0.009-0.039, = 0.002 for oxaloacetate; β: 0.083, 95% CI: 0.032-0.135, = 0.002 for 2-AAA) scores after adjusting for age, education level, and operation time.
High preoperative blood levels of oxaloacetate and 2-AAA were associated with increased risk of postoperative dNCR.
https://classic.clinicaltrials.gov/ct2/show/NCT05105451, identifier NCT05105451.
本研究旨在确定与手术后脑认知功能恢复延迟（dNCR）相关的术前血液生物标志物。
对 67 名（≥65 岁）接受全身麻醉下头颈部肿瘤切除术的患者进行了简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评估。使用广泛靶向代谢组学技术确定了术前血清代谢组学。
在 67 名患者中，25 名患者发生了 dNCR，并与其余 42 名无 dNCR 的随机选择的 25 名患者相匹配。使用变量重要性投影> 1.0 的正交偏最小二乘判别分析、错误发现率<0.05、倍数变化> 1.2 或<0.83 的标准选择差异代谢物，以最大限度地减少假阳性。术后 oxaloacetic 酸（OR：1.054，95%CI：1.027-1.095，= 0.001）和 2-氨基己二酸（2-AAA）（OR：1.181，95%CI：1.087-1.334，= 0.001）的术前血清水平与调整麻醉持续时间、教育程度和年龄后术后 dNCR 相关。oxaloacetic 酸和 2-AAA 的曲线下面积分别为 0.86（灵敏度：0.84，特异性：0.88）和 0.86（灵敏度：0.84，特异性：0.84）。术前高水平的 oxaloacetic 酸和 2-AAA 也与术后 MoCA 评分降低相关（β：0.022，95%CI：0.005-0.04，= 0.013，用于 oxaloacetic 酸；β：0.077，95%CI：0.016-0.137，= 0.014，用于 2-AAA）和 MMSE（β：0.024，95%CI：0.009-0.039，= 0.002，用于 oxaloacetic 酸；β：0.083，95%CI：0.032-0.135，= 0.002，用于 2-AAA），在调整年龄、教育程度和手术时间后。
术前血液 oxaloacetic 酸和 2-AAA 水平升高与术后 dNCR 风险增加相关。
https://classic.clinicaltrials.gov/ct2/show/NCT05105451，标识符 NCT05105451。
