目的 探讨外周血血浆中5种生物标记物的水平与术后认知功能障碍（postoperative cognitive dysfunction, POCD）发生、发展的关系，从而为POCD的早期诊断、治疗和判断预后提供可能的依据。 方法 选择择期行骨科手术的45例老年患者行前瞻性临床研究，术后3 d依据简易智力状态检查量表（Mini-Mental State Examination, MMSE）评分将患者分为POCD组（18例）和非POCD组（NPOCD组，27例）。两组患者血浆中的5种生物标记物［激肽释放酶6（kallikrein-6, KLK6）、超氧化物歧化酶1（superoxide dismutase 1, SOD1）、超氧化物歧化酶2（superoxide dismutase 2, SOD2）、骨桥蛋白（osteopontin, OPN）、接触蛋白-1（contactin-1, CNTN1）］分别在3个时间点［术前（preoperation, PREOP）、术后1 d（postoperative day 1, POD1）、术后3 d（postoperative day 3, POD3）］进行检测。统计分析血浆中生物标记物的水平与患者POCD之间的关系。 结果 纳入45例患者，其中18例患者（40%）在POD3发生认知功能障碍。患者术前血浆中KLK6的基础水平两组间差异无统计学意义（P>0.05），POD1时POCD组患者血浆中KLK6的水平显著低于NPOCD组（P<0.05），POD3时POCD组患者血浆中KLK6的水平显著低于NPOCD组（P<0.01），且POCD组患者POD1、POD3时血浆中KLK6的水平均较术前显著降低（P<0.01）；患者PREOP、POD1、POD3时血浆中ln（SOD1）、ln（SOD2）、ln（OPN）、CNTN1的水平两组间差异均无统计学意义（P>0.05）。POCD组患者在POD3时血浆中ln（SOD1）的水平较术前显著降低（P<0.05），POCD组患者在POD1、POD3时血浆中ln（OPN）的水平均较术前显著升高（P<0.05），并且POCD组患者POD1、POD3时血浆中CNTN1的水平均较术前显著降低（P<0.01），而POCD组患者POD1、POD3时血浆中ln（SOD2）的水平与术前比较差异均无统计学意义（P>0.05）。 结论 血浆中 KLK6 水平降低与老年患者早期POCD的发生、发展有关，而 SOD1、SOD2、OPN、CNTN1的表达水平与术后认知功能的关系尚不明确。
Ｏｂｊｅｃｔｉｖｅ To determine the relationship between five biomarkers and the progression of postoperative cognitive dysfunction (POCD), so as to provide potential basis and new insights for early diagnosis, prevention and therapy for POCD. Methods A total of 45 elderly patients who underwent elective orthopedics surgery were enrolled into the current prospective study. According to their Mini-Mental State Examination (MMSE) scores at three days after operation, the patients were divided into a POCD group (n=18) and a non-POCD group (NPOCD group, n=27). The levels of five biomarkers ［kallikrein-6 (KLK6), superoxide dismutase 1 (SOD1), superoxide dismutase 2 (SOD2), osteopontin (OPN) and contactin-1 (CNTN1)］ in plasma were measured at three time points: pre-operation (PREOP), one day after operation (POD1) and three days after operation (POD3). The relationship between biomarkers in plasma and POCD was calculated based on statistical analysis. Results There were 18(40%) patients with the presence of cognitive dysfunction. There was no significant difference in the basal level of KLK6 in plasma between the two groups (P>0.05) at PREOP. The plasma level of KLK6 of the POCD group at POD1 was significant lower (P<0.05) than that of the NPOCD group, and the plasma level of KLK6 of the POCD group at POD3 was significant lower (P<0.01) than that of the NPOCD group. Meanwhile, the plasma level of KLK6 at POD1 and POD3 were significant lower (P<0.05) than that in POCD group at PREOP, respectively. There was no significant difference in the basal level of ln (SOD1), ln (SOD2), ln (OPN) and CNTN1 in plasma between the two groups (P>0.05). The plasma level of ln (SOD1) at POD3 were significant lower (P<0.05) than that in POCD group at PREOP, and the plasma level of ln (OPN) at POD1 and POD3 were significant higher (P<0.05) than that in POCD group at PREOP respectively, while the plasma level of CNTN1 at POD1 and POD3 were significant lower(P<0.01) than that in the POCD group at PREOP respectively. However, there was no significant difference in the plasma level of ln (SOD2) at POD1 and POD3 compared with PREOP in POCD group (P>0.05). Conclusions The decrease of KLK6 level in plasma is related to the occurrence and development of POCD in elderly patients. However，the correlation between the expression levels of SOD1, SOD2, OPN and CNTN1 and postoperative cognitive function is still unclear.
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