脑脊液黑色素聚集激素联合其他相关标记物对老年患者术前认知功能障碍的预测价值

The predictive value of melanin-concentrating hormone combined with other related biomarkers in cerebrospinal fluid in preoperative cognitive dysfunction of elderly patients

目的探讨脑脊液黑色素聚集激素(MCH)联合其他相关标记物对老年患者术前认知功能障碍的预测价值。方法前瞻性纳入2022年3至11月内蒙古赤峰市医院拟在椎管内麻醉下行择期髋或膝关节置换术的80例老年患者,其中男32例,女48例,年龄65~85(70.7±5.2)岁。根据蒙特利尔认知评估量表(MoCA)诊断结果将患者分为术前认知功能障碍组(n=23)和对照组(n=57)。采用ELISA测定脑脊液中MCH、β淀粉样蛋白40(Aβ_(40))、β淀粉样蛋白42(Aβ_(42))及磷酸化Tau蛋白(p-tau)水平。绘制受试者工作特征(ROC)曲线,评估各指标单独或联合应用对术前认知功能障碍的预测价值。采用Spearman秩相关性分析检验各指标水平与MoCA评分的相关性。结果术前认知功能障碍组脑脊液MCH、Aβ_(40)、Aβ_(42)、p-tau、Aβ_(42)/p-tau水平分别为(35.53±5.94)μg/L、(39.21±9.18)ng/L、(221.83±43.17)ng/L、(42.64±9.74)ng/L、5.53±1.92,对照组分别为(28.74±4.90)μg/L、(36.37±7.87)ng/L、(280.23±45.67)ng/L、(35.00±9.27)ng/L、8.62±2.78;与对照组相比,术前认知功能障碍组MCH、p-tau水平升高(均P<0.01),Aβ_(42)、Aβ_(42)/p-tau水平降低(均P<0.001)。MCH、Aβ_(42)/p-tau具有较高的预测价值,ROC曲线下面积(AUC)分别为0.807(95%CI:0.703~0.911)、0.842(95%CI:0.741~0.943),灵敏度分别为78.3%、87.0%,特异度分别为75.4%、94.7%。MCH联合Aβ_(42)/p-tau具有更高的预测价值,AUC为0.915(95%CI:0.837~0.992),灵敏度和特异度分别为87.0%和86.0%。脑脊液MCH、p-tau水平与MoCA评分呈负相关(r=-0.467、-0.321,均P<0.01);脑脊液Aβ_(42)、Aβ_(42)/p-tau水平与MoCA评分呈正相关(r=0.480、0.520,均P<0.001)。结论脑脊液MCH水平升高与老年患者术前认知功能障碍发生有关,MCH联合Aβ_(42)/p-tau预测价值最大。

Objective To explore the predictive value of cerebrospinal fluid melanin-concentrating hormone(MCH)combined with other related biomarkers in preoperative cognitive dysfunction of elderly patients.Methods A total of 80 patients who underwent elective hip or knee replacement under intravertebral anesthesia in Chifeng Municipal Hospital,Inner Mongolia,from March to November 2022 were prospectively included,with 32 males and 48 females,and aged 65-85(70.7±5.2)years old.According to the evaluation results of the Montreal Cognitive Assessment(MoCA),patients were divided into the preoperative cognitive dysfunction(n=23)and control(n=57)groups.The levels of MCH,amyloid-β40(Aβ_(40)),amyloid-β42(Aβ_(42)),and phosphorylated tau protein(p-tau)in cerebrospinal fluid were determined by enzyme-linked immunosorbent assay(ELISA).The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of each biomarker separately or in combination for preoperative cognitive dysfunction.Spearman′s rank correlation analysis was utilized to test the correlation between the level of each biomarker and MoCA scores.Results The levels of MCH,Aβ_(40),Aβ_(42),p-tau,and Aβ_(42)/p-tau in the preoperative cognitive dysfunction group were(35.53±5.94)μg/L,(39.21±9.18)ng/L,(221.83±43.17)ng/L,(42.64±9.74)ng/L,and 5.53±1.92,and the levels of these biomarkers in the control group were(28.74±4.90)μg/L,(36.37±7.87)ng/L,(280.23±45.67)ng/L,(35.00±9.27)ng/L,and 8.62±2.78,respectively.Compared with the control group,the levels of cerebrospinal fluid MCH and p-tau in the preoperative cognitive dysfunction group were significantly increased(all P<0.01),and the levels of Aβ_(42)and Aβ_(42)/p-tau were significantly decreased(all P<0.001).MCH and Aβ_(42)/p-tau provided higher predictive values.The area under the curve(AUC)of MCH and Aβ_(42)/p-tau were 0.807(95%CI:0.703-0.911)and 0.842(95%CI:0.741-0.943),the sensitivity were 78.3%and 87.0%,and the specificity were 75.4%and 94.7%.MCH combined with Aβ_(42)/p-tau have the higher AUC of 0.915(95%CI:0.837-0.992),the sensitivity(87.0%)and specificity(86.0%)were both high,which had a higher predictive value.The levels of cerebrospinal fluid MCH and p-tau were negatively correlated with MoCA score(r=-0.467,-0.321,all P<0.01),and the levels of Aβ_(42)and Aβ_(42)/p-tau were positively correlated with MoCA score(r=0.480,0.520,all P<0.001).Conclusion The increase in cerebrospinal fluid MCH levels is associated with preoperative cognitive dysfunction in elderly patients.MCH combined with Aβ_(42)/p-tau has the greatest predictive value.