术前血浆C1q、C3b及神经颗粒素与老年患者肺叶切除术后谵妄的关系  

Association between C1q, C3b, neurogranin and postoperative delirium in elderly patients undergoing pulmonary lobectomy

作　　者：鲁振[1] 高蓉[1] LU Zhen;GAO Rong(Department of Anesthesiology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院麻醉科

出　　处：《临床麻醉学杂志》2019年第10期945-947,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨术前血浆炎性因子C1q、C3b及神经颗粒素与老年肺叶切除术患者术后谵妄(POD)的关系。方法择期全身麻醉下行胸腔镜肺叶切除术的老年患者94例,男53例,女41例,年龄≥65岁,ASAⅠ-Ⅲ级,根据是否发生POD将患者分为两组:POD组和非POD组。于术前24 h行简易智力状态检查量表(MMSE)评分并抽外周血检测血浆C1q、C3b与神经颗粒素浓度;术后第1~3天采用混乱评估法对患者进行POD评估。采用受试者工作特征(ROC)曲线分析炎性因子预测POD的效能。结果有21例患者(22.3%)发生POD(POD组)。POD组术前血浆C1q、C3b、神经颗粒素浓度明显高于非POD组(P<0.05),住院时间明显长于非POD组(P<0.05),术前MMSE评分明显低于非POD组(P<0.05)。术前血浆C1q、C3b及神经颗粒素预测POD的曲线下面积分别为0.89(0.78~0.99)、0.87(0.79~0.96)及0.89(0.80~0.98)(P<0.05)。结论POD患者术前血浆C1q、C3b及神经颗粒素浓度明显升高,因而通过监测这些指标可能对POD早期诊断与防治有一定价值。Objective To investigate the association between plasma levels of cytokines and neurogranin and the incidence of postoperative delirium(POD)in elderly patients undergoing pulmonary lobectomy.Methods Ninty-four patients scheduled for pulmonary lobectomy,53 males and 41 females,aged≥65 years,falling into ASA physical statusⅠ-Ⅲ,were divided into two groups according to whether POD occurred:POD group and non-pod group.Mini-mental state examination(MMSE)was used to assess cognitive performance,and blood was obtained to measure plasma levels of cytokines(C1q and C3b)and synaptic related proteins(neurogranin)24 h before surgery.POD was diagnosed daily for 3 d postoperatively by the confusion assessment method.The receiver operating characteristic(ROC)curve was used to analyze inflammatory factors to predict POD performance.Results The incidence of POD was 22.3%(21/94).Compared with non-POD group,there was significantly prolonged hospital stay but lower preoperative MMSE scores in POD group(P<0.05).There were also significantly higher preoperative plasma levels of C1q and C3b and neurogranin in POD group than those in non-POD group(P<0.05).The areas under the ROC curves of preoperative C1q,C3b,and neurogranin for predicting POD were 0.89(0.78-0.99),0.87(0.79-0.96),and 0.89(0.80-0.98),respectively.Conclusion Plasma levels of C1q and C3b and neurogranin are higher in POD patients,thus may be helpful for early diagnosis and prevention of POD.

关 键 词：肺叶切除术 老年患者 术后请妄 补体 神经颗粒素 

分 类 号：R655.3[医药卫生—外科学] R614[医药卫生—临床医学]