血清外泌体miR-29C表达水平与老年手术患者术后认知功能障碍的相关性  

Correlation between the expression level of serum exosome miR-29C and postoperative cognitive dysfunction in elderly patients undergoing surgery

作　　者：南官江 杨建新[2] 丁莹 程子健 和浩杰 Nan Guanjiang;Yang Jianxin;Ding Ying;Cheng Zijian;He Haojie(School of Anesthesiology,Shanxi Medical University,Taiyuan 030000,China;Department of Pain,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学麻醉学院,太原030000 [2]山西医科大学第二医院疼痛科,太原030001 [3]山西医科大学第二医院麻醉科,太原030001

出　　处：《中国医师杂志》2023年第5期680-684,共5页Journal of Chinese Physician

基　　金：山西省卫生健康委科研项目(2019043)。

摘　　要：目的探讨血清外泌体miR-29C表达水平与老年手术患者术后认知功能障碍(POCD)的相关性。方法选取2021年1月至2022年1月于山西医科大学第二医院择期行脊柱手术的老年患者119例,于术前1 d和术后1、7、21 d对入选患者行蒙特利尔认知评估(MoCA)量表评分,依据术前1 d与术后1 d的MoCA量表评分是否下降≥2分将所选患者分为POCD组(51例)和非POCD组(68例),并对所有患者术前1 d和术后1 d的S100-β、神经元特异性烯醇化酶(NSE)浓度及血清外泌体miR-29C表达水平进行检测和分析。Pearson相关分析MoCA量表评分与S100-β、NSE、miR-29C的相关性。受试者工作特征(ROC)曲线评价S100-β、NSE、miR-29C对老年手术患者发生POCD的预测价值。结果POCD组患者术后1、7及21 d的MoCA量表评分均较术前1 d明显下降(均P<0.05),而非POCD组患者仅术后1 d的MoCA量表评分均较术前1 d明显下降(P<0.05)。两组患者术后1 d的S100-β、NSE浓度及血清外泌体miR-29C的表达水平均较术前1 d明显升高(均P<0.05),且POCD组患者术后1 d时S100-β、NSE浓度及血清外泌体miR-29C的表达水平均明显高于非POCD组(均P<0.05)。POCD组患者术后1 d的MoCA量表评分与血清外泌体miR-29C的表达水平呈负相关(P<0.05)。ROC曲线分析显示,术后1 d的NSE、S100-β、外泌体miR-29C的表达水平预测老年手术患者发生POCD风险的曲线下面积(AUC)分别为0.891、0.908、0.918。结论老年手术患者POCD的发生与血清外泌体miR-29C表达水平的升高有关,且血清外泌体miR-29C的表达水平与MoCA量表评分呈负相关,对其早期监测可对老年患者术后POCD的发生发展、病情判断及临床干预提供依据。Objective To investigate the correlation between the expression level of serum exosome miR-29C and postoperative cognitive dysfunction(POCD)in elderly patients undergoing surgery.Methods A total of 119 elderly patients who underwent elective spinal surgery in the Second Hospital of Shanxi Medical University from January 2021 to January 2022 were selected and scored on the Montreal Cognitive Assessment(MoCA)Scale 1 day before surgery and 1,7 and 21 days after surgery.The selected patients were divided into POCD group(51 cases)and non-POCD group(68 cases)according to whether the MoCA Scale score decreased≥2 points 1 day before surgery and 1 day after surgery.S100-β,neuron-specific enolase(NSE)levels and serum exosome miR-29C expression levels were detected and analyzed in all patients 1 day before and 1 day after surgery.Pearson correlation analysis showed the correlation between MoCA Scale score and S100-β,NSE and miR-29C.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of S100-β,NSE and miR-29C for POCD occurrence in elderly patients undergoing surgery.Results The score of MoCA Scale in POCD group were significantly decreased 1,7 and 21 days after surgery compared with 1 day before surgery(all P<0.05),while the score of MoCA Scale in non-POCD group were significantly decreased only 1 day after surgery compared with 1 day before surgery(P<0.05).The levels of S100-βand NSE and the expression level of serum exosome miR-29C in 2 groups were significantly increased 1 day after surgery compared with 1 day before surgery(all P<0.05).Moreover,the levels of S100-βand NSE and the expression level of serum exosome miR-29C in POCD group were significantly higher than those in non-POCD group 1 day after surgery(all P<0.05).There was a negative correlation between the MoCA Scale score and the expression level of serum exosome miR-29C 1 day after surgery in the POCD group(P<0.05).ROC curve analysis showed that the expression levels of NSE,S100-βand exosome miR-29C 1 day after surgery

关 键 词：外泌体 miR-29C 术后认知并发症 老年人 

分 类 号：R614[医药卫生—麻醉学]