脑脊液PGRN与老年患者膝关节置换术后认知功能障碍的关系

Relationship between progranulin in cerebrospinal fluid and postoperative cognitive dysfunction after knee replacement in elderly patients

目的评价脑脊液颗粒蛋白前体(PGRN)与老年患者膝关节置换术后认知功能障碍(POCD)的关系。方法择期行单侧全膝关节置换术患者230例,性别不限,年龄65~90岁,体重50~80 kg,ASA分级Ⅰ或Ⅱ级,拟行麻醉方法为脊椎-硬膜外联合阻滞。抽取患者术前外周静脉血和脑脊液各2 ml,离心去沉淀后-80℃冰箱中冷冻保存。记录患者受教育年限、术前简易精神状态量表(MMSE)评分、术中失血量、手术时间和术后VAS评分等。采用ELISA法测定脑脊液PGRN、Aβ40、Aβ42、t-tau和p-tau蛋白的浓度,采用PCR法检测AopE基因的表达。于术前1 d、术后入麻醉恢复室、术后1、3和7 d进行神经心理学测试,根据患者是否发生POCD,将患者分为POCD组(P组)和非POCD组(NP组)。采用logistic回归分析筛选POCD的危险因素。结果NP组177例,P组53例,POCD发生率为23.0%。与NP组比较,P组患者年龄升高,术前脑脊液PGRN、Aβ40和Aβ42蛋白浓度降低,t-tau和p-tau蛋白浓度升高(P<0.05)。logistic回归分析结果显示,脑脊液PGRN浓度升高是膝关节置换术老年患者POCD发生的独立危险因素(P<0.05)。结论脑脊液PGRN浓度升高是膝关节置换术老年患者POCD发生的独立危险因素。

Objective To evaluate the relationship between progranulin(PGRN)in cerebrospinal fluid(CSF)and postoperative cognitive dysfunction(POCD)after knee replacement in elderly patients.Methods Two hundred and thirty patients of both sexes,aged 65-90 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,undergoing elective unilateral total knee replacement were enrolled in this study,and the anesthesia method was combined spinal-epidural block.Preoperative peripheral venous blood samples and CSF 2 ml were extracted,centrifuged to remove precipitation and stored in a-80℃refrigerator.Years of education,preoperative Mini-Mental State Examination score,intraoperative blood loss,operation time,and postoperative visual analog scale score were recorded.The concentrations of PGRN,Aβ40,Aβ42,t-tau and p-tau in CSF were determined by enzyme-linked immunosorbent assay,and the expression of AopE gene was detected by polymerase chain reaction.The neuropsychological testing was performed on 1 day before operation,on admission to anesthesia recovery room,and on 1,3 and 7 days after operation.The patients were divided into POCD group(P group)and non-POCD(NP group)according to whether POCD occurred.Logistic regression analysis was used to analyze the related risk factors for POCD.Results There were 177 cases in NP group and 53 cases in P group,and the incidence of POCD was 23.0%.Compared with NP group,the age of patients was significantly increased,preoperative concentrations of PGRN,Aβ40 and Aβ42 protein in CSF were decreased,and the concentrations of t-tau and p-tau protein were increased in P group(P<0.05).The results of logistic regression analysis showed that increase in PGRN concentrations in CSF was the independent risk factor for POCD(P<0.05).Conclusion Increase in PGRN concentrations in CSF is the independent risk factor for POCD after knee replacement in elderly patients.