摘要
目的 评价脑脊液β淀粉样蛋白42与tau浓度比值(Aβ-42/tau)预测老年患者发生术后认知功能障碍(POCD)的准确性.方法 拟在脊椎-硬膜外联合麻醉下行全髋或膝关节置换术患者80例,性别不限,年龄65 ~ 85岁,ASA分级Ⅱ或Ⅲ级,经L34间隙穿刺,蛛网膜下腔穿刺成功后取2 ml脑脊液,检测Aβ-42和tau的浓度(单位为pg/ml),计算二者比值.于术前1 d和术后7d进行神经心理学测验,采用Z计分法确定POCD,根据是否发生POCD,分为非POCD组和POCD组.利用ROC曲线确定区分POCD患者与非POCD患者的截断值.结果 32例患者发生了POCD,发生率为40%,非POCD组和POCD组脑脊液Aβ-42/tau分别为2.6±0.3、1.7±0.4,POCD组低于非POCD组(P<0.01).以脑脊液Aβ-42/tau预测发生POCD的灵敏度为91.7%,特异度为81.2%,约登指数为0.7.ROC曲线区分POCD患者与非POCD患者脑脊液Aβ-42/tau的截断值为2.0.结论 脑脊液Aβ-42/tau可准确地预测老年患者POCD发生.
Objective To evaluate the accuracy of cerebrospinal fluid (CSF) amyloid beta 42 (Aβ-42) to tau level ratio (Aβ-42/tau) in predicting postoperative cognitive dysfunction (POCD) in elderly patients.Methods Eighty ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 65-85 yr,undergoing elective total hip or knee replacement under combined spinal-epidural anesthesia,were enrolled in the study.Epidural catheter was placed at T3,4 interspace,and after a catheter was successfully placed into the subarachnoid space,CSF 2 ml was obtained to measure Aβ-42 and tau levels (units:pg/ml),and the ratio between them was calculated.Neuropsychological tests were performed at 1 day before surgery and 1 week after surgery.The Z score was used to identity POCD.The cut-off value for POCD and nonPOCD patients was determined by using ROC curve.Results Thirty-two patients were diagnosed with POCD,and the incidence was 40%.The Aβ-42/tau was 2.6±0.3 and 1.7±0.4 in non-POCD and POCD groups,respectively,and the ratio was significantly lower in POCD group than in non-POCD group.The sensitivity of CSF Aβ-42/tau in predicting POCD was 91.7%,the specificity was 81.2%,and Youden index was 0.7.ROC curves revealed that the cut-off value for POCD and non-POCD patients was 2.0.Conclusion CSF Aβ-42/tau can accurately predict the occurrence of POCD in elderly patients.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2015年第4期405-408,共4页
Chinese Journal of Anesthesiology
基金
青岛市卫生局立项课题(2012-WSZD012)
关键词
淀粉样Β蛋白
TAU蛋白质类
脑脊髓液
预测
认知障碍
手术后并发症
老年人
Amyloid beta-protein
tau proteins
Cerebrospinal fluid
Forecasting
Cognition disorders
Postoperative complications
Aged