CAJ | 학술논문

目的评价脑脊液β淀粉样蛋白42与tau浓度比值(Aβ-42/tau)预测老年患者发生术后认知功能障碍(POCD)的准确性.方法拟在脊椎-硬膜外联合麻醉下行全髋或膝关节置换术患者80例,性别不限,年龄65 ～ 85岁,ASA分级Ⅱ或Ⅲ级,经L34间隙穿刺,蛛网膜下腔穿刺成功后取2 ml脑脊液,检测Aβ-42和tau的浓度(单位为pg/ml),计算二者比值.于术前1 d和术后7d进行神经心理学测验,采用Z计分法确定POCD,根据是否发生POCD,分为非POCD组和POCD组.利用ROC曲线确定区分POCD患者与非POCD患者的截断值.结果 32例患者发生了POCD,发生率为40％,非POCD组和POCD组脑脊液Aβ-42/tau分别为2.6±0.3、1.7±0.4,POCD组低于非POCD组(P＜0.01).以脑脊液Aβ-42/tau预测发生POCD的灵敏度为91.7％,特异度为81.2％,约登指数为0.7.ROC曲线区分POCD患者与非POCD患者脑脊液Aβ-42/tau的截断值为2.0.结论脑脊液Aβ-42/tau可准确地预测老年患者POCD发生.
목적 평개뇌척액β정분양단백42여tau농도비치(Aβ-42/tau)예측노년환자발생술후인지공능장애(POCD)적준학성.방법 의재척추-경막외연합마취하행전관혹슬관절치환술환자80례,성별불한,년령65 ～ 85세,ASA분급Ⅱ혹Ⅲ급,경L34간극천자,주망막하강천자성공후취2 ml뇌척액,검측Aβ-42화tau적농도(단위위pg/ml),계산이자비치.우술전1 d화술후7d진행신경심이학측험,채용Z계분법학정POCD,근거시부발생POCD,분위비POCD조화POCD조.이용ROC곡선학정구분POCD환자여비POCD환자적절단치.결과 32례환자발생료POCD,발생솔위40％,비POCD조화POCD조뇌척액Aβ-42/tau분별위2.6±0.3、1.7±0.4,POCD조저우비POCD조(P＜0.01).이뇌척액Aβ-42/tau예측발생POCD적령민도위91.7％,특이도위81.2％,약등지수위0.7.ROC곡선구분POCD환자여비POCD환자뇌척액Aβ-42/tau적절단치위2.0.결론 뇌척액Aβ-42/tau가준학지예측노년환자POCD발생.
Objective To evaluate the accuracy of cerebrospinal fluid (CSF) amyloid beta 42 (Aβ-42) to tau level ratio (Aβ-42/tau) in predicting postoperative cognitive dysfunction (POCD) in elderly patients.Methods Eighty ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 65-85 yr,undergoing elective total hip or knee replacement under combined spinal-epidural anesthesia,were enrolled in the study.Epidural catheter was placed at T3,4 interspace,and after a catheter was successfully placed into the subarachnoid space,CSF 2 ml was obtained to measure Aβ-42 and tau levels (units:pg/ml),and the ratio between them was calculated.Neuropsychological tests were performed at 1 day before surgery and 1 week after surgery.The Z score was used to identity POCD.The cut-off value for POCD and nonPOCD patients was determined by using ROC curve.Results Thirty-two patients were diagnosed with POCD,and the incidence was 40％.The Aβ-42/tau was 2.6±0.3 and 1.7±0.4 in non-POCD and POCD groups,respectively,and the ratio was significantly lower in POCD group than in non-POCD group.The sensitivity of CSF Aβ-42/tau in predicting POCD was 91.7％,the specificity was 81.2％,and Youden index was 0.7.ROC curves revealed that the cut-off value for POCD and non-POCD patients was 2.0.Conclusion CSF Aβ-42/tau can accurately predict the occurrence of POCD in elderly patients.