脑胶质瘤患者立体定向切除术前后认知功能变化及β-EP、3-NT预测认知功能障碍价值探讨

Changes of cognitive function before and after stereotactic resection in patients with Brain glioma and the value of β-EP and 3-NT in predicting cognitive dysfunction

目的探讨脑胶质瘤(BG)患者立体定向切除术前后认知功能变化及β内啡肽(β-EP)、3-硝基络氨酸(3-NT)预测认知功能障碍(CD)的价值。方法选取我院2018年3月~2021年10月BG患者113例,均行立体定向切除术治疗,评估术前、术后2周认知功能(MoCA评分),根据MoCA评分变化分CD组、正常组。对比两组基线资料、术前、术后1d、术后2周β-EP、3-NT水平,分析CD独立影响因素,建立Logistic回归模型并进行评价,受试者工作特征曲线(ROC)分析β-EP、3-NT对CD的预测价值。结果113例患者术后2周MoCA评分(27.31±1.03)分高于入院时MoCA评分(23.65±1.47)分(P<0.05),CD发生率为25.66%;CD组病灶最大径、肿瘤分级为Ⅲ~Ⅳ级、术前癫痫者、术前、术后1 d、术后2周3-NT水平高于正常组,术前、术后1 d、术后2周β-EP水平低于正常组(P<0.05);校正病灶最大径、肿瘤分级、术前癫痫后,3-NT、β-EP为CD的独立影响因素(P<0.05);建立Logistic回归模型:logit(P)=4.603+0.384×术后1 d 3-NT-1.000×术后1 dβ-EP,拟合度较好;β-EP、3-NT联合预测发生CD的AUC大于单一指标预测值(P<0.05)。结论BG患者经立体定向切除术后认知功能好转,但仍有部分患者术后发生CD,β-EP、3-NT联合预测BG患者发生CD具有较高的效能。

Objective To investigate the changes of cognitive function before and after stereotactic resection in patients with Brain glioma(BG)and the prediction of cognitive dysfunction(CD)byβ-endorphin(β-EP)and 3-nitrotyrosine(3-NT)the value of.Methods A total of 113 patients with BG from March 2018 to October 2021 in our hospital were selected and all received stereotactic resection.The cognitive function(MoCA score)was evaluated before operation and 2 weeks after operation,and the patients were divided into CD group and normal group according to the change of MoCA score.The baseline data,preoperative,postoperative 1d,and 2 weeks postoperativeβ-EP and 3-NT levels were compared between the two groups.The independent influencing factors of CD were analyzed.Logistic regression model was established and evaluated.Receiver operating characteristic curve(ROC)was used to analyze the predictive value ofβ-EP and 3-NT for CD.Results The MoCA score of 113 patients 2 weeks after operation of(27.31±1.03)was higher than that of(23.65±1.47)at admission(P<0.05),and the incidence of CD was 25.66%.The largest diameter of the lesion,the tumor grade of gradeⅢ-Ⅳ,the patients with preoperative epilepsy,the level of 3-NT before surgery,1d after surgery,and 2 weeks after surgery in the CD group were higher than those in the normal group,and the levels ofβ-EP before operation,1d after operation and 2 weeks after operation were lower than those in normal group(P<0.05).After adjusting for the largest diameter of the lesion,tumor grade,and preoperative epilepsy,3-NT andβ-EP were independent influencing factors of CD(P<0.05).Logistic regression model was established:logit(P)=4.603+0.384×1d postoperative 3-NT-1.000×1d postoperativeβ-EP,and the fit was good.The AUC ofβ-EP and 3-NT combined to predict the occurrence of CD was greater than the predicted value of single index(P<0.05).Conclusion Cognitive function of BG patients improved after stereotactic resection,but some patients still developed CD after operation.