血浆hnRNP A2/B1与Aβ_(42)和P-tau在术前诊断轻度认知功能障碍中的应用价值

Anesthesia Management of Elderly Patient The application value of plasma heterogeneous nuclear ribonucleoprotein A2/B1,Aβ_(42)and P-tau in the preoperative diagnosis of mild cognitive dysfunction

目的探讨血浆核内不均一核糖核蛋白A2/B1(heterogeneous nuclear rib nucleoprotein A2/B1,hnRNP A2/B1)、β淀粉样蛋白42(amyloid-β_(42),Aβ_(42))及磷酸化tau蛋白(phosphorylated tau protein,P-tau)水平在术前诊断老年患者轻度认知功能障碍(mild cognitive impairment,MCI)的应用价值。方法纳入2020年6月至2021年3月于天津市第三中心医院行择期手术患者200例,年龄65~80岁。根据国际MCI工作组标准及欧洲阿尔茨海默病联合会工作组标准将患者分为MCI组(n=100)与对照组(n=100),每组男58例、女42例。术前检测患者血浆hnRNP A2/B1、Aβ_(42)及P-tau水平,计算其诊断MCI的灵敏度、特异度及准确度,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估各指标的诊断价值。结果MCI组血浆hnRNP A2/B1、Aβ_(42)及P-tau水平[M(Q_(1),Q_(3))]分别为310.0(275.1,344.2)、34.5(24.9,42.5)、190.4(150.4,301.7)ng/L,显著高于对照组的272.7(239.6,291.5)、18.7(14.7,26.6)、140.0(101.8,217.5)ng/L(均P<0.05)。以国际MCI工作组标准为金标准,血浆hnRNP A2/B1预测MCI的灵敏度、特异度与ROC曲线下面积(area under the ROC curve,AUC)分别为80%、61%、0.781,Aβ_(42)预测MCI的灵敏度、特异度与AUC分别为78%、73%、0.744,P-tau预测MCI的灵敏度、特异度与AUC分别为51%、79%、0.675。hnRNP A2/B1与Aβ_(42)预测MCI的灵敏度、特异度与AUC差异均无统计学意义(均P>0.05),但两者灵敏度均高于P-tau(均P<0.001);与P-tau相比,血浆hnRNP A2/B1预测MCI的AUC较高(P<0.05)。当3种指标联合时,其灵敏度为82%,AUC为0.842,均为最高,但特异度(71%)降低(均P<0.05)。结论血浆hnRNP A2/B1、Aβ_(42)及P-tau三者联合可提高术前诊断老年患者MCI的灵敏度和准确度,诊断效能最大,有一定临床应用价值。

Objective To explore the application value of plasma heterogeneous nuclear ribonucleoprotein A2/B1(hnRNP A2B1),β-amyloid 42(Aβ_(42))and phosphorylated tau protein(P-tau)levels in elderly patients in the preoperative diagnosis of mild cognitive impairment(MCI).Methods A total of 200 patients who underwent elective surgery at Tianjin Third Central Hospital from June 2020 to March 2021were Enrolled,regardless of gender,age 65-80 years old.According to the international MCI working group standards and the European Alzheimer′s Disease Federation working group standards,patients were divided into MCI group and control group.There were 58 males and 42 females in each group.The patient′s plasma hnRNP A2/B1,Aβ_(42)and P-tau levels were detected before operation.The sensitivity,specificity and accuracy of the diagnosis of MCI were calculated.The receiver operating characteristic curve were drew to evaluate the diagnostic value of each index.Results The plasma levels of hnRNP A2/B1,Aβ_(42)and P-tau in the MCI group were 310.0(275.1,344.2),34.5(24.9,42.5),190.4(150.4,301.7)ng/L,respectively,which were significantly higher than those of the control group[272.7(239.6,291.5),18.7(14.7,26.6),140.0(101.8,217.5)ng/L].The differences were statistically significant(all P<0.05).Taking the international MCI working group standard as the gold standard,the sensitivity,specificity and area under the ROC curve(AUC)of plasma hnRNP A2/B1 for predicting MCI were 80%,61%,and 0.781,respectively.The sensitivity,specificity and AUC of plasma Aβ_(42)for predicting MCI were 78%,73%,and 0.744.The sensitivity,specificity,and AUC of P-tau for predicting MCI were 51%,79%,and 0.675,respectively.The sensitivity,specificity and AUC of hnRNP A2/B1 and Aβ_(42)in predicting MCI were not statistically significant(all P>0.05),but the sensitivity of both were higher than P-tau(all P<0.001).Compared with P-tau,the AUC of plasma hnRNP A2/B1 was higher when predicting MCI(P<0.05).When the three indicators were combined,the sensitivity was 82%,and the AUC was 0.842,both of which were the highest,but the specificity reduced(71%)(all P<0.05).Conclusions Plasma hnRNP A2/B1 combined with Aβ_(42)and P-tau levels can improve the sensitivity and accuracy of MCI diagnosis in elderly MCI patients before surgery,and have the greatest diagnostic efficiency.It has certain application value.