膝关节/髋关节置换术患者脑脊液中NPTX2水平降低与术后谵妄的相关性：一项前瞻性队列研究。
Association of reduced cerebrospinal fluid NPTX2 levels with postoperative delirium in patients undergoing knee/hip replacement: a prospective cohort study.
作者信息
Guo Zongxiao, Hong Xiaoli, Wang Xiang, Chen Weiguo, Guo Zongfeng
机构信息
Department of Orthopedic Surgery, Hai'an People's Hospital, Haian, China.
Department of Anesthesiology, Hai'an People's Hospital, Haian, China.
出版信息
Aging Clin Exp Res. 2024 Feb 17;36(1):42. doi: 10.1007/s40520-023-02670-x.
BACKGROUND
Postoperative delirium (POD) is a common complication with poor prognosis in the elderly, but its mechanism has not been fully elucidated. There is evidence that the changes in synaptic activity in the brain are closely related to the occurrence of POD. And neuronal pentraxin 2 (NPTX2) can regulate synaptic activity in vivo.
AIMS
This study aims to explore whether decreased NPTX2 levels affects POD and whether the cerebrospinal fluid (CSF) biomarkers of POD mediate this association.
METHODS
In this prospective cohort study, we interviewed patients with knee/hip replacement 1 day before surgery to collect patient information and assess their cognitive function. CSF was extracted for measuring the CSF levels of NPTX2 and other POD biomarkers on the day of surgery. And postoperative follow-up visits were performed 1-7 days after surgery.
RESULTS
Finally, 560 patients were included in the study. The patients were divided into POD group and NPOD (non-POD) group. The POD group had a median age of 80 years, a female proportion of 45%, a median BMI of 24.1 kg/m, and a median years of education of 9 years. The Mann-Whitney U test showed that CSF NPTX2 levels were significantly lower in POD group, compared with the NPOD group (P < 0.05). Univariate binary logistic regression analysis showed that reduced CSF levels of NPTX2 protected against POD (crude OR = 0.994, 95% CI 0.993-0.995, P < 0.001). The receiver-operating characteristic (ROC) curve indicated that CSF NPTX2 level had high predictive value for POD. Mediation analyses showed that CSF T-tau (mediating proportion = 21%) and P-tau (mediating proportion = 29%) had significant mediating effects on the association between CSF NPTX2 and POD.
CONCLUSION
CSF NPTX2 levels were associated with the occurrence of POD. Low CSF NPTX2 levels may be an independent protective factor for POD. CSF T-tau and P-tau could mediate the association between CSF NPTX2 and POD occurrence.
CLINICAL TRIAL REGISTRATION
The trial registration number (TRN): ChiCTR2200064740, Date of Registration: 2022-10-15.
背景
术后谵妄（POD）是老年人常见的并发症，预后较差，但其机制尚未完全阐明。有证据表明，大脑中突触活动的变化与POD的发生密切相关。而神经元五聚体蛋白2（NPTX2）可在体内调节突触活动。
目的
本研究旨在探讨NPTX2水平降低是否会影响POD，以及POD的脑脊液（CSF）生物标志物是否介导这种关联。
方法
在这项前瞻性队列研究中，我们在手术前1天对接受膝关节/髋关节置换术的患者进行访谈，以收集患者信息并评估其认知功能。在手术当天提取CSF，以测量NPTX2和其他POD生物标志物的CSF水平。并在术后1-7天进行术后随访。
结果
最终，560例患者纳入研究。患者分为POD组和NPOD（非POD）组。POD组的中位年龄为80岁，女性比例为45%，中位BMI为24.1kg/m，中位受教育年限为9年。曼-惠特尼U检验显示，与NPOD组相比，POD组的CSF NPTX2水平显著降低（P<0.05）。单因素二元逻辑回归分析显示，CSF中NPTX2水平降低可预防POD（粗OR=0.994，95%CI 0.993-0.995，P<0.001）。受试者工作特征（ROC）曲线表明，CSF NPTX2水平对POD具有较高的预测价值。中介分析显示，CSF总tau蛋白（T-tau）（中介比例=21%）和磷酸化tau蛋白（P-tau）（中介比例=29%）对CSF NPTX2与POD之间的关联具有显著的中介作用。
结论
CSF NPTX2水平与POD的发生有关。CSF中NPTX2水平低可能是POD的独立保护因素。CSF T-tau和P-tau可介导CSF NPTX2与POD发生之间的关联。
临床试验注册
试验注册号（TRN）：ChiCTR2200064740，注册日期：2022年10月15日。
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