脑脊液α-突触核蛋白寡聚体与髋关节置换术后认知功能障碍的关系

The association between cerebrospinal fluidα-synuclein oligomers and postoperative cognitive dysfunction in patients undergoing hip arthroplasty

目的:探讨脑脊液中α-突触核蛋白寡聚体(o-α-syn)与老年患者髋关节置换术后认知功能障碍(POCD)的关系。方法:选取择期行髋关节置换术的136例老年患者作为研究对象,患者拟行蛛网膜下隙阻滞,抽取脑脊液2 mL。记录患者手术时长、体质量指数、年龄、性别、术中出血量等。分别于术前1 d、术后7 d评估认知功能。将术后发生POCD为POCD组,采用1∶1配对,从未发生POCD的患者中选取病例数,为Non-POCD组。采用ELISA法测量两组脑脊液中的总α-突触核蛋白(t-α-syn)、o-α-syn、Aβ40、Aβ42的浓度。结果:发生POCD有17例,POCD发生率为16%。两组患者受教育年限、性别、年龄、BMI、术前MMSE评分、术中失血量和手术时间均无统计学差异。与Non-POCD组比较,POCD组MMSE、DST2、CDT评分降低(P<0.05);与Non-POCD组比较,POCD组t-α-syn、o-α-syn、Aβ40、Aβ42均显著升高(P<0.05)。Logistic回归分析结果显示,t-α-syn(OR=1.003,95%CI:1.000~1.006,P<0.05)、o-α-syn (OR=1.245,95%CI:1.020~1.520,P<0.05)、Aβ40(OR=1.001,95%CI:1.000~1.002,P<0.05)、Aβ42(OR=1.024,95%CI:1.006~1.043,P<0.05)均是老年人髋关节置换术后认知功能障碍的危险因素。ROC曲线分析提示,o-α-syn是预测POCD曲线下面积为0.749(P<0.05)。结论:脑脊液中o-α-syn浓度升高是老年髋关节置换患者术后发生认知功能障碍的独立危险因素,是预测POCD的一个良好的指标。

Objective:To investigate the association between cerebrospinal fluidα-synuclein oligomers and postoperative cognitive dysfunction(POCD)in elderly patients undergoing hip arthroplasty.Methods:136 elderly patients who underwent hip arthroplasty were selected as the research subjects.The patients were scheduled to undergo subarachnoid block and 2 mL of cerebrospinal fluid was extracted.The patient s surgical duration,body mass index,age,gender,and intraoperative bleeding volume were recorded.Cognitive function was assessed 1 day pre-operatively and on postoperative day 7 respectively.According to whether POCD occurred after surgery,the patients were divided into POCD group and Non-POCD group.The concentrations of totalα-synucleoprotein(t-α-syn),o-α-syn,Aβ40 and Aβ42 in cerebrospinal fluid were detected by ELISA.Results:There were 17 cases of POCD,and the incidence of POCD was 16%.No significant differences were detected in years of education,age,sex ratio,BMI,preoperative MMSE score,intraoperative blood loss and operation time between the two groups.Compared with Non-POCD group,MMSE,DST2 and CDT scores in POCD group were lower(P<0.05).Compared with the Non POCD group,the t-α-syn,o-α-syn,Aβ40 and Aβ42 of the POCD group increased(P<0.05).Logistic regression analysis showed that t-α-syn(OR=1.003,95%CI:1.0~1.006,P<0.05),o-α-syn(OR=1.245,95%CI:1.020~1.520,P<0.05),Aβ40(OR=1.001,95%CI:1.0~1.002,P<0.05),Aβ42(OR=1.024,95%CI:1.006~1.043,P<0.05)were the independent risk factors for postoperative cognitive dysfunction in the elderly patients underwent hip arthroscopy(P<0.05).ROC curve analysis suggested that o-α-syn could be used as a predictor of POCD,and the AUC was 0.749(P<0.05).Conclusion:The concentration of o-α-syn in cerebrospinal fluid is an independent risk factor for postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty and is a good predictor of POCD.