老年患者关节置换术前脑脊液miR-125b及miR-181c水平与术后谵妄的关系

Relationship between levels of miR-125b and miR-181c in cerebrospinal fluid before joint replace- ment and postoperative delirium in elderly patients

目的 评价老年患者关节置换术前脑脊液微小RNA-125b（miR-125b）及miR-181c水平与术后谵妄（POD）的关系。方法 择期蛛网膜下腔阻滞下行髋/膝关节置换术患者52例，性别不限，年龄≥65岁，体重45～70 kg ，ASA分级Ⅰ-Ⅲ级。蛛网膜下腔穿刺成功后抽取脑脊液，采用荧光定量PCR法检测miR-181c和miR-125b水平。术后第1和2天采用中文版意识模糊评估量表将患者分为POD组和非POD组。结果 髋/膝关节置换术老年患者POD发生率约为28%。与非POD组相比，POD组术前脑脊液miR-181c水平升高（P〈0.05），miR-125b水平差异无统计学意义（P〉0.05）。结论 老年患者术前脑脊液miR-181c水平与POD有关，可作为POD的危险因素。

Objective To evaluate the relationship between the levels of microRNA-125b（miR-125b）and miR-181c in cerebrospinal fluid（CSF）before joint replacement and postoperative delirium（POD）in elderly patients.Methods Fifty-two patients of both sexes, aged ≥65 yr, weighing 45-70 kg, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective hip or knee replacement under spinal anesthesia, were included in the study.CSF was collected after successful puncture to measure the levels of miR-181c and miR-125b by fluorescent quantitative real-time polymerase chain reaction.The patients were divided into POD group and non-POD group using the Chinese reversion of Confusion Assessment Method on postoperative days 1 and 2.Results The incidence of POD was about 28% in the patients underwent hip or knee replacement.Compared with non-POD group, the preoperative level of miR-181c in CSF was significantly increased（P〈0.05）, and no significant change was found in the preoperative level of miR-125b in CSF in POD group（P〉0.05）.Conclusion The level of miR-181c in CSF before joint replacement is related to POD in elderly patients, and the preoperative level of miR-181c in CSF is a risk factor for POD.