Research Of Potential Pathogenic Molecules In Serum Of Perioperative Neurocognitive Disorders After Transurethral Resection Prostatectomy In Elderly Patients

Objective: Perioperative neurocognitive disorders(PND),a common surgical complication of elderly patients,occurred after the big and emergency surgery which caused the decline of the ability of memory,attention,language comprehension and social communication.As a result,seriously influencing the postoperative outcome via prolonging hospitalization,increasing the long-term complications and mortality.Due to pathogenesis remains unclear,so lack of effective prevention and interventions.Therefore,in this study,Isobaric tags for relative and absolute quantification(i TRAQ)technique was used to screen the differentially expressed proteins of PND and non-PND patients,thus providing a new idea for the mechanism research and prevention strategy of PND.Methods: According to the inclusion and exclusion criteria,a total of 229 elderly patients who underwent electroprostatectomy from March 2019 to December 2019 in our hospital were collected.All patients were divided into PND group and non-PND group in accordance with Z score method at postoperative day 3.Three patients were selected from PND group and non-PND respectively to perform the i TRAQ proteomics analysis,and preoperative index such as ASA grading,BMI,MMSE score and complications,as well as intraoperative index such as operation time,anesthesia time,intraoperative fluid intake and blood loss between the two subgroup were not statistical difference.After the peripheral blood collction,blood samples were centrifuged to extract the serum for i TRAQ test.The differentially expressed proteins of PND were screened by i TRAQ proteomics.Then,the potential functions of differentially expressed proteins were further explored through GO analysis,KEGG pathway analysis and Domain analysis.Results: Based on Z score,32 patients who developed cognitive dysfunction on postoperative day 3 were classified as PND group,while the remaining 190 patients who did not develop postoperative cognitive dysfunction were classified as non-PND group.The incidence of PND after electroprostatectomy in elderly patients was 14.41%.Compared with the non-PND group,the patients in the PND group were older and had higher incidence of hypertensio1.At last,229 patients completed the plasma prostatectomy under laryngeal mask under general anesthesiastudy.Finally,222 patients were enrolled in this study.n and diabetes(P<0.05).There was no significant difference in ASA grade,BMI and preoperative MMSE score between the two groups(P 0.05).There were no statistically significant differences in operation time,anesthesia time,intraoperative fluid intake and blood loss between the two groups(P 0.05).Three patients in the PND group and the non-PND group were selected for i TRAQ proteomics analysis according to the principle of preoperative and intraoperative index consistency.There were no statistically significant differences in ASA grading,BMI,MMSE score and complications between the two groups of patients who selected fori TRAQ proteomics analysis(P 0.05).There were no statistically significant differences in operation time,anesthesia time,intraoperative fluid intake and blood loss between the two groups of patients who selected for i TRAQ proteomics analysis(P 0.05).2.A total of 1,101 proteins were detected by i TRAQ proteomics.Compared with non-PND patients,8 differentially expressed proteins were screened according to the standard of p<0.05 and ratio >1.2.Among them,six up-regulated proteins were exhibited as follows:Tektin-2,Hephaestin,Methylcytosine dioxygenase TET2,HLA class I histocompatibility antigen,Tubulin beta-2a chain,RUN and FYVE domain-containing protein 1;two down-regulated proteins were exhibited as follows: E3 ubiquitin-protein ligase RNF213,Rho guanine nucleotide exchange factor 9;The GO analysis,KEGG pathway analysis and Domain analysis of differentially expressed proteins were further carried out,and the results revealed that differentially expressed proteins were mainly involved in the biological process of cells,in the composition of cell components,in the phagocytosis process,and with the RING Domain of E3 ubiquitin ligase.Conclusion: The incidence of PND in elderly patients undergoing electroprostatectomy was 14.41%.According to the i TRAQ proteomic analysis,there were 8 differentially expressed proteins in serum of PND patients compared with non-PND patients.The differentially expressed protein has the RING domain of E3 ubiquitin ligase,participating in the biological processes and cellular components of cells,involving endocytosis and phagocytosis.These biological function may be the potential mechanisms leading to the occurrence of PND.