南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (4): 574-578.doi: 10.12122/j.issn.1673-4254.2021.04.14

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脑脊液中β淀粉样蛋白42和神经丝轻链蛋白水平与术后神经认知功能障碍的相关性：基于90例66~78岁患者

张雪卫，傅 强   

  • 出版日期:2021-04-20 发布日期:2021-04-30

Correlation of cerebrospinal fluid amyloid β-protein 42 and neurofilament light protein levels with postoperative neurocognitive dysfunction in elderly patients

  • Online:2021-04-20 Published:2021-04-30

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摘要： 目的 检测β淀粉样蛋白42（Aβ42）和神经丝轻链蛋白（NFL）在老年患者脑脊液中的表达情况，并探讨其与患者发生术后神经认知功能障碍（PNCD）的相关性。方法 选取2017年1月~2018年12月在解放军301医院麻醉科接受脊椎-硬膜外联合麻醉下行髋关节或膝关节置换术的90例老年患者作为研究对象。采用ELISA 法检测脑脊液中Aβ42和NFL的浓度水平。于术前1 d和术后7 d采用简易认知状态评价量表（MMSE）对患者进行认知评估；采用相关神经认知功能测试后，以Z 值计分法判定患者是否发生PNCD。Spearman秩相关分析脑脊液Aβ42和NFL的表达与MMSE评分的相关性。采用受试者工作特征曲线（ROC）曲线分析脑脊液Aβ42和NFL水平对PNCD的预测价值。结果 90例老年患者中有38例术后发生PNCD，发生率为42.2%。PNCD组患者脑脊液Aβ42为1.96 ng/mL，明显低于非PNCD组的2.54 ng/mL（t=3.29，P<0.05）；而PNCD组患者脑脊液浓度值为4.59 ng/mL，明显高于非PNCD组（3.16 ng/mL）（t=3.72，P<0.05）。患者脑脊液Aβ42与MMSE分值存在正相关（r=-0.659，P< 0.05）；脑脊液NFL浓度水平与MMSE分值存在负相关（r=-0.626，P<0.05）。ROC曲线分析结果，脑脊液Aβ42和NFL预测PNCD的的曲线下面积(AUC)分别为为0.744和0.768，而二者联合预的ROC曲线下AUC为0.847。结论 PNCD患者术前脑脊液Aβ42和NFL明显高于非PNCD患者。脑脊液中Aβ42和NFL浓度水平均可预测老年患者PNCD的发生，联合二者的诊断价值更高。

关键词: 术后认知功能障碍；脑脊液；β淀粉样蛋白42；神经丝轻链蛋白

Abstract: Objective To detect cerebrospinal fluid levels of amyloid beta- protein 42 (Aβ42) and neurofilament light protein (NFL) and explore their correlation with postoperative neurocognitive dysfunction (PNCD) in elderly patients. Methods A total of 90 elderly patients undergoing hip or knee replacement with joint epidural anesthesia in our Hospital between January, 2017 and December, 2018 were recruited in this study. The levels of Aβ42 and NFL in the cerebrospinal fluid were detected using ELISA. Simple cognitive status assessment scale (MMSE) was used to evaluate the cognitive status of the patients 1 day before and 7 days after the surgery. All the patients underwent neurocognitive function tests, and the z-score method was used to determine the occurrence of PNCD. Spearman rank correlation analysis was used to analyze the correlation of Aβ42 and NFL levels in the cerebrospinal fluid with MMSE scores. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of cerebrospinal fluid Aβ42 and NFL levels for PNCD. Results PNCD occurred in 38 of the 90 elderly patients, with an incidence of 42.2%. The level of Aβ42 in the cerebrospinal fluid was significantly lower in PNCD group than in the non-PNCD group (1.96 vs 2.54 ng/mL; t=3.29, P<0.05); the concentration of NFL in the cerebrospinal fluid was significantly higher in PNCD group than in non- PNCD group (4.59 vs 3.16 ng/mL; t=3.72, P<0.05). Aβ42 level in the cerebrospinal fluid was positively correlated while NFL was negatively correlated with the MMSE score of the patients (r=-0.659，P<0.05; r=-0.626，P< 0.05). ROC curve analysis showed that the area under the curve (AUC) of cerebrospinal fluid Aβ42 and NFL levels were 0.744 and 0.768, respectively; the AUC of their combination was 0.847 for prediction of PNCD. Conclusions Elderly patients with PNCD have significantly higher levels of Aβ42 and NFL in the cerebrospinal fluid than those without PNCD. Both Aβ42 and NFL levels in the cerebrospinal fluid can help to predict the occurrence of POCD in elderly patients, and their combination has a higher diagnostic value.

Key words: postoperative cognitive dysfunction; cerebrospinal fluid; amyloid beta-protein 42; neurofilament light protein