Xu Maokai, Chen Yingjie, Lin Yujun, Wang Danfeng, Zheng Xiaochun
Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China.
Department of Critical Care Medicine, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China.
Front Neurosci. 2025 Feb 28;19:1525230. doi: 10.3389/fnins.2025.1525230. eCollection 2025.
Postoperative delirium (POD) is a frequent and challenging complication in elderly surgical patients, marked by abrupt cognitive and attentional disturbances. Current POD diagnosis depends on clinical assessments that are time-intensive and lack predictive accuracy before surgery. Although previous research has explored biomarkers such as neuroinflammatory factors and Alzheimer's-related proteins to enhance POD prediction, single molecular markers have proven insufficient for reliable prognosis.
This study investigated serum exosomal miRNA expression profiles in postoperative patients to assess their association with POD. We compared miRNA expression between POD and non-POD groups through cognitive assessments and serum analyses. Additionally, enrichment analysis was conducted to determine the biological pathways regulated by differentially expressed miRNAs.
Our analysis identified 57 miRNAs with significantly altered expression between POD and non-POD patients, including 16 upregulated and 41 downregulated miRNAs in the POD group. Enrichment analysis revealed that these miRNAs are involved in genes regulating neurotrophin signaling, neuroactive ligand-receptor interactions, and pathways that influence neuronal plasticity and cell viability.
This study highlights specific miRNAs as potential biomarkers for POD and suggests their involvement in the underlying mechanisms of cognitive decline following surgery. By enhancing diagnostic capabilities and identifying potential therapeutic targets, our findings could lead to more effective POD management strategies for elderly patients. Further research is recommended to validate these miRNAs and evaluate their clinical utility for predictive screening and therapeutic interventions.
术后谵妄（POD）是老年外科患者常见且具有挑战性的并发症，其特征为突发的认知和注意力障碍。目前POD的诊断依赖于临床评估，这种评估耗时且在手术前缺乏预测准确性。尽管先前的研究已经探索了诸如神经炎症因子和阿尔茨海默病相关蛋白等生物标志物以增强POD的预测，但单一分子标志物已被证明不足以进行可靠的预后评估。
本研究调查了术后患者血清外泌体miRNA表达谱，以评估其与POD的关联。我们通过认知评估和血清分析比较了POD组和非POD组之间的miRNA表达。此外，进行了富集分析以确定差异表达的miRNA所调控的生物学途径。
我们的分析确定了57种在POD患者和非POD患者之间表达有显著变化的miRNA，其中POD组中有16种miRNA上调，41种miRNA下调。富集分析表明，这些miRNA参与调控神经营养因子信号传导、神经活性配体-受体相互作用以及影响神经元可塑性和细胞活力的途径的基因。
本研究强调了特定的miRNA作为POD潜在生物标志物的作用，并表明它们参与了术后认知功能下降的潜在机制。通过提高诊断能力和识别潜在的治疗靶点，我们的发现可能会为老年患者带来更有效的POD管理策略。建议进一步研究以验证这些miRNA，并评估它们在预测性筛查和治疗干预中的临床效用。
