目的：分析血浆外泌体（exosome）miR-409-3p与冠状动脉搭桥术围术期神经认知障碍（perioperative neurocognitive disorders, PND）的相关性。方法：本研究共纳入76 例冠状动脉搭桥术患者，于术前 1 天和术后 7 天进行神经心理测试评估，并根据评估结果将患者分为PND组（n=24例）和非PND组（n=52例）。收集提取所有患者血浆外泌体，分别采用透射电镜、粒径分析、western blot对其进行鉴定。采用qRT-PCR检测外泌体miR?409-3p的表达水平。Logistic 回归分析PND发生的危险因素。结果：发生PND 24 例，未发生 PND52 例。两组在年龄、手术时间及教育年限方面具有统计学差异。血浆外泌体miR-409-3p在PND患者中的表达高于非PND患者。年龄、 手术时间及外泌体 miR-409-3p为PND 发生的独立危险因素。结论：高表达的血浆外泌体 miR-409-3p可作为冠状动脉搭桥术PND的新型分子标志物。
Objective: To analyze the correlation between plasma exosomal miR-409-3p and perioperative neurocognitive disorders (PND) after coronary artery bypass grafting. Methods: A total of 76 patients undergoing coronary artery bypass graft surgery were enrolled in this study. Neuropsychological test assessments were performed 1 day before and 7 days after surgery, and the patients were divided into PND group (n=24 cases) and non-PND group according to the evaluation results (n=52 cases). The plasma exosomes of all patients were collected and extracted, and they were identified by transmission electron microscopy, particle size analysis, and western blot. qRT-PCR was used to detect the expression level of exosomal miR-409-3p. Logistic regression analysis was used to evaluate the risk factors for PND. Results: There were 24 cases of PND and 52 cases of non-PND. There were statistical differences in age, operation time and education years. The expression of plasma exosomal miR-409-3p in PND patients was higher than that in non-PND patients. Age, operation time, and plasma exosomal miR-409-3p were independent risk factors for PND. Conclusion: The highly expressed plasma exosomal miR-409-3p can be used as a new molecular marker for PND in patients undergoing coronary artery bypass graft surgery.