脑脊液α-突触核蛋白浓度预测患者术后谵妄的价值

Value of α-synuclein concentration in cerebrospinal fluid in predicting postoperative delirium

目的探讨脑脊液(CSF)α-突触核蛋白(α-syn)浓度预测术后谵妄(POD)的价值。方法选择本院2018年1月至2020年9月择期硬膜外-脊椎联合麻醉手术患者1000例,选择L3,4间隙进行穿刺,到达蛛网膜下腔后,取CSF 2 ml,采用ELISA法测定CSFα-syn、β-淀粉样蛋白(Aβ)40、Aβ42、总tau蛋白(T-tau)、磷酸化tau蛋白(P-tau)浓度。记录不同年龄段患者CSFα-syn浓度和POD发生情况。根据是否发生POD分为POD组和非POD组,并以年龄、ASA分级、受教育程度、手术时长、术中失血量5个匹配变量进行频率匹配(1∶1)。结果本研究最终纳入841例患者,POD发生率为15.0%。匹配后POD组126例,非POD组126例。随着年龄增长,CSFα-syn浓度及POD发生率逐渐升高(P<0.05)。与非POD组比较,POD组CSFα-syn、T-tau、P-tau浓度升高,Aβ40、Aβ42浓度降低,Aβ40/P-tau、Aβ42/P-tau、Aβ42/Aβ40、P-tau/T-tau降低(P<0.05)。logistic回归分析校正混杂因素后,CSFα-syn、p-tau、T-tau浓度升高为POD的危险因素,CSF Aβ40、Aβ42浓度升高,Aβ40/P-tau、Aβ42/P-tau升高为POD的保护因素(P<0.05)。多元线性回归分析:CSFα-syn浓度与Aβ40、Aβ42浓度呈负相关,与P-tau、T-tau浓度呈正相关(P<0.05)。CSFα-syn浓度预测POD的受试者工作特征曲线下面积为0.895,Youden指数为0.664,灵敏度为80.00%,特异度为86.36%(P<0.001)。结论CSFα-syn浓度与POD发生相关,其预测POD的准确性较高。

Objective To investigate the value ofα-synuclein(α-syn)concentration in cerebrospinal fluid(CSF)in predicting postoperative delirium(POD).Methods One thousand patients underwent elective surgery with combined epidural-spinal anesthesia in our hospital from January 2018 to September 2020 were selected.The epidural puncture was performed at L3,4 interspace,and 2 ml of CSF was collected after the needle reaching the subarachnoid space.The concentrations ofα-syn,β-amyloid(Aβ)40,Aβ42,total tau protein(T-tau),and phosphorylated tau protein(P-tau)in CSF were determined by enzyme-linked immunosorbent assay.The concentrations ofα-syn in CSF and occurrence of POD in patients of different ages were recorded.Patients were divided into POD group and non-POD group according to whether POD occurred,and frequency matching(1∶1)was performed based on five matching variables of age,ASA physical status,education level,duration of operation,and intraoperative blood loss.Results Eight hundred and forty-one patients were finally included in the study,and the incidence of POD was 15.0%.There were 126 cases in POD group and 126 cases in non-POD group after matching.The concentrations ofα-syn in CSF and incidence of POD were gradually increased with age(P<0.05).Compared with non-POD group,the concentrations ofα-syn,T-tau and P-tau in CSF were significantly increased,the concentrations of Aβ40 and Aβ42 were decreased,Aβ40/P-tau,Aβ42/P-tau,Aβ42/Aβ40 and P-tau/T-tau were decreased in POD group(P<0.05).After confounding factors were corrected by logistic regression analysis,increased concentrations ofα-syn,p-tau,and T-tau in CSF were risk factors for POD(P<0.05).Increased concentrations of Aβ40 and Aβ42 in CSF and increased Aβ40/P-tau and Aβ42/P-tau were protective factors for POD(P<0.05).Multiple linear regression analysis showed that the concentration ofα-syn in CSF was negatively correlated with Aβ40 and Aβ42 concentrations and positively correlated with P-tau and T-tau concentrations(P<0.05).The area under the receiver operating characteristic curve of concentrations ofα-syn in CSF predicting POD was 0.895,Youden index was 0.664,sensitivity was 80.00%,and specificity was 86.36%(P<0.001).Conclusion The concentration ofα-syn in CSF is related to the occurrence of POD,and it provides higher accuracy in predicting POD.