摘要 目的 评价脑脊液及血浆中可溶性髓样细胞触发受体（sTREM）水平对老年患者术后认知功能障碍(POCD)的预测价值。 方法 选择蛛网膜下隙-硬膜外间隙联合麻醉下行全膝关节置换术的患者80例，年龄65～85岁，美国麻醉医师协会（ASA）分级Ⅰ～Ⅲ级。于术前1 d采集每一位患者肘静脉血5 mL，腰硬联合穿刺成功后采集脑脊液2 mL，使用ELISA法检测脑脊液和血浆中sTREM1、sTREM2水平。于术前1 d、术后1周对患者进行神经心理学测试，采用Z计分法确定患者是否发生POCD，根据是否发生POCD，分为POCD组(P组)和非POCD组(NP组)。利用ROC曲线计算P组与NP组cut-off值，并根据曲线下面积（AUC）判断两者诊断POCD的准确度。 结果 19例患者发生了POCD，发生率为24％。P组患者脑脊液、血浆中sTREM1、sTREM2水平均明显高于NP组（t=2.12～8.13,P＜0.05)。其中，脑脊液中sTREM1预测发生POCD的灵敏度为75％，特异度为86％，约登指数为0.61，cut-off值为70.6,AUC为0.839，预测能力高于血浆中sTREM1（AUC为0.821）、血浆中sTREM2（AUC为0.732）及脑脊液中sTREM2（AUC为0.768）。 结论 脑脊液及血浆中sTREM1、sTREM2水平均可预测老年患者POCD的发生，但以脑脊液中sTREM1预测POCD发生的准确度较高。 Abstract：Objective To evaluate the value of levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM1) and soluble triggering receptor expressed on myeloid cells-2 (sTREM2) in cerebrospinal fluid (CSF) and plasma in predicting postoperative cognitive dysfunction (POCD) in elderly patients. Methods Eighty American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients aged 65-85 years, who underwent total knee arthroplasty under combined spinal-epidural anesthesia, were enrolled in this study. Cubital venous blood (5 mL) was collected 1 d before operation, and CSF (2 mL) was extracted after successful combined spinal-epidural puncture. The levels of sTREM1 and sTREM2 in CSF and plasma were measured by ELISA. Neuropsychological tests were carried out 1 d before operation and at 1 week after operation. Z score was used to determine the presence or absence of POCD. According to whether POCD occurred, these patients were divided into POCD (P) group and non-POCD (NP) group. The cut-off values for P group and NP group were calculated by using the receiver operative curve (ROC), and the accuracy of sTREM1 and sTREM2 in predicting POCD was judged by the area under the ROC curve (AUC). Results POCD occurred in 19 patients (24%). The P group had significantly higher levels of sTREM1 and sTREM2 in CSF and plasma than the NP group (t=2.12-8.13,P<0.05). In predicting the development of POCD, sTREM1 in CSF had a sensitivity of 75%, a specificity of 86%, and a Youden index of 0.61 at a cut-off value of 70.6, and showed a significantly higher predictive ability than sTREM1 in plasma and sTREM2 in plasma and CSF (AUC: 0.839 vs 0.821, 0.732, and 0.768). Conclusion The levels of sTREM1 and sTREM2 in CSF and plasma can be used to predict the development of POCD in elderly patients, but the level of sTREM1 in CSF has the highest predictive accuracy
