老年全麻术患者血清HIF-1α,S-100β蛋白,BDNF水平及rSO_(2)的动态检测与围术期神经认知紊乱的相关性分析

Correlation Analysis of Dynamic Detection of Serum HIF-1α,S-100βProtein,BDNF and rSO_(2)with Perioperative Neurocognitive Disorders in Elderly Patients Undergoing General Anesthesia

目的探讨老年全身麻醉患者血清低氧诱导因子-1α(HIF-1α)、S-100β蛋白、脑源性神经营养因子(BDNF)、脑氧饱和度(rSO_(2))变化与围术期神经认知紊乱(PND)的相关性。方法选择2019年3月~2020年9月海口市第三人民医院手术室接诊的141例接受全身麻醉手术的老年患者,将术后7天MMSE评分<26分和(或)MoCA评分<26分患者归为PND组(33例),其余为认知功能正常组(108例)。分别于术前、术后1天、3天、7天检测血清HIF-1α,S-100β蛋白、BDNF水平以及rSO_(2)。分析HIF-1α,S-100β蛋白、BDNF,rSO_(2)与MMSE评分、MoCA评分相关性。结果PND组年龄大于认知功能正常组(t=3.106,P<0.05),初中文化程度比例高于认知功能正常组(χ^(2)=10.517,P<0.05),差异均有统计学意义。PND组和认知功能正常组围术期间MMSE评分、MoCA评分、BDNF水平呈先降低后升高变化趋势(F=8.005~13.054,均P<0.001),血清HIF-1α,S-100β蛋白水平、rSO_(2)呈先升高后降低趋势(F=7.882~17.154,P<0.001)。PND组术后1天、3天、7天MMSE评分、MoCA评分、BDNF水平低于认知功能正常组(F=12.54~18.094,均P<0.05),血清HIF-1α,S-100β蛋白水平、rSO_(2)高于认知功能正常组(F=15.346~25.134,均P<0.05)。Pearson相关分析结果显示认知障碍组患者血清HIF-1α,S-100β蛋白水平、rSO_(2)与MoCA评分、MMSE评分均呈负相关(MoCA:r=-0.506~-0.563,MMSE:r=-0.532~-0.601,均P<0.001),BDNF水平与MoCA评分、MMSE评分均呈正相关(r=0.597,0.534,均P<0.001)。联合HIF-1α,S-100β蛋白、BDNF,rSO_(2)诊断老年全身麻醉患者围术期PND的曲线下面积(AUC)为0.901,高于单独诊断的0.709,0.717,0.718和0.705(P<0.05)。结论老年全身麻醉手术围术期血清HIF-1α,S-100β蛋白水平、rSO_(2)升高,BDNF水平降低与认知功能损伤密切相关,可作为老年全身麻醉术后PND早期识别和病情评估的参考指标。

Objective To investigate the correlation between changes in serum hypoxic-inducible factor-1α(HIF-1α),S-100βprotein,brain-derived neurotrophic factor(BDNF),cerebral oxygen saturation(rSO_(2))and perioperative neurocognitive disorders(PND)in elderly patients undergoing general anesthesia.Methods A total of 141 elderly patients admitted to the operating room of the Third People’s Hospital of Haikou City from March 2019 to September 2020 received general anesthesia were selected.PND group(33 cases)included patients with postoperative 7d MMSE score<26 points and/or MoCA score<26 points,and the remaining patients were normal cognitive function group(108 cases).The correlation between HIF-1α,S-100βprotein,BDNF,rSO_(2)with MMSE score and MoCA score was analyzed.Results The age of PND group was higher than that of the normal cognitive function group(t=3.106,P<0.05),and the proportion of junior high school was higher than that of the normal cognitive function group(χ^(2)=10.590,P<0.05),the differences were statistically significant.During perioperative period,MMSE score,MoCA score,BDNF level in PND group and normal cognitive function group showed a trend of first decrease and then increase(F=8.005~13.054,all P<0.001),while serum HIF-1α,S-100βprotein level and rSO_(2)showed a trend of first increase and then decrease(F=7.882~17.154,all P<0.001).The level of MMSE scores,MoCA scores,BDNF in PND group were lower than those in the normal cognitive function group(F=12.54~18.094,all P<0.05),and the levels of HIF-1α,S-100βprotein and rSO_(2)were higher than those in the normal cognitive function group(F=15.346~25.134,all P<0.05).Pearson rank correlation analysis showed that serum HIF-1α,S-100βprotein and rSO_(2)level were negatively correlated with MoCA score and MMSE score in the cognitive impairment group(MoCA:r=-0.506~-0.563,MMSE:r=-0.532~-0.601,all P<0.001),while BDNF level were positively correlated with MoCA score and MMSE score(r=0.597 and 0.534,all P<0.001).Combined with HIF-1α,S-100βprotein,BDNF and rSO_(2),the area under the curve(AUC)in the diagnosis of perioperative PND in elderly patients under general anesthesia was 0.901,which was higher than that of 0.709,0.717,0.718 and 0.705(all P<0.05).Conclusion Increased serum HIF-1α,S-100βprotein and rSO_(2),decreased BDNF level were closely related to cognitive impairment during the perioperative period of general anesthesia in the elderly,and can be used as a reference index for early recognition and assessment of PND after general anesthesia.