老年肺叶切除术前血浆MMP-9、C1q及脂联素变化与术后谵妄的相关性  

Correlation Between the Changes of Plasma MMP-9,C1q and Adiponectin in Elderly Patients Undergoing Lobectomy Before Operation and the Postoperative Delirium

作　　者：郑红[1] 陈晓霞[1] 韩李周[1] 陈苗[1] 皇甫娟[1] Zheng Hong;Chen Xiaoxia;Han-Li Zhou;Chen Miao;Huang-Fu Juan(Jiaozuo City People's Hospital,Jiaozuo 454000 China)

机构地区：[1]焦作市人民医院,河南焦作454000

出　　处：《锦州医科大学学报》2022年第2期70-74,共5页Journal of Jinzhou Medical University

基　　金：2020年河南省科技攻关项目,项目编号:LHGJ20200835;。

摘　　要：目的探讨老年肺叶切除术患者术前血浆基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、补体1q(complement 1q,C1q)及脂联素(adiponectin,ADP)变化及与术后谵妄(postoperative delirium,POD)的相关性。方法选取我院2019年1月至2020年1月收治的332例行肺叶切除术患者,根据术后1~7 d是否谵妄分为两组,POD组48例,非POD组284例,测定各组术前血浆MMP-9、C1q、ADP水平,中文版记忆谵妄评定量表(memory delirium rating scale,MDAS)评估谵妄严重程度,分析术前血浆MMP-9、C1q、ADP水平与POD的相关性。结果POD组术前合并症指数和血浆MMP-9、C1q及术后MDAS评分明显高于非POD组,营养状况、躯体功能和血浆ADP水平明显低于非POD组(t/Z=-2.907、13.346、16.406、22.793、-4.219、-3.162、13.567,P<0.05)。Pearson相关性分析显示,POD组术后MDAS评分与术前血浆MMP-9、C1q水平呈正相关,与ADP水平呈负相关(r=6.389、0.681、-0.583,P<0.001)。多因素Logistic回归分析显示,重度合并症(OR=2.991,95%CI:1.955~4.600,P=0.007)、营养状况差(OR=5.881,95%CI:3.548~8.575,P<0.001)、重度功能障碍(OR=5.143,95%CI:3.912~8.834,P=0.001)、MMP-9(OR=1.040,95%CI:1.009~1.072,P=0.011)、C1q(OR=1.043,95%CI:1.020~1.066,P<0.001)为肺叶切除术ADP独立危险因素,ADP(OR=0.241,95%CI:0.180~0.526,P=0.012)为独立保护因素。ROC曲线显示,血浆MMP-9(AUC=0.897,95%CI:0.859~0.927)、C1q(AUC=0.849,95%CI:0.806~0.886)、ADP(AUC=0.848,95%CI:0.805~0.885)水平预测肺叶切除术ADP的敏感度和特异度为82.58%、77.89%、81.25%和76.06%、81.34%、74.51%。结论POD患者术前血浆MMP-9、C1q水平明显提升,ADP水平明显降低,为POD独立危险因素,可作为早期诊断和防治POD的指标。Objective To investigate the changes of preoperative plasma matrix metalloproteinase-9(MMP-9),complement 1q(C1q)and adiponectin(ADP)in elderly patients undergoing lobectomy and the postoperative delirium(POD).Methods A total of 332 patients undergoing lobectomy in our hospital from January 2019 to January 2020 were selected and divided into two groups according to whether they suffered from delirium after 1 to 7 days operation.There were 48 cases in the POD group and 284 cases in the non-POD group.The preoperative plasma MMP-9,C1q,and ADP levels were measured in each group.The Chinese version of the Memory Delirium Assessment Scale(MDAS)was used to assess the severity of delirium,and the correlation between preoperative plasma MMP-9,C1q,ADP levels and POD was analyzed.Results The preoperative comorbidity index and the scores of plasma MMP-9,C1q and postoperative MDAS in the POD group were significantly higher than those in the non-POD group,and the nutritional status,physical function and plasma ADP levels were significantly lower than those of the non-POD group(t/Z=-2.907,13.346,16.406,22.793,-4.219,-3.162,13.567,all P<0.05).Pearson correlation analysis showed that the postoperative MDAS score in the POD group was positively correlated with preoperative plasma MMP-9 and C1q levels,and negatively correlated with ADP levels(r=6.389,0.681,-0.583,all P<0.001).Multifactorial Logistic regression analysis showed that severe comorbidity(OR=2.991,95%CI:1.955~4.600,P=0.007),poor nutritional status(OR=5.881,95%CI:3.548~8.575,P<0.001),severe functional impairment(OR=5.143,95%CI:3.912~8.834,P=0.001),MMP-9(OR=1.040,95%CI:1.009~1.072,P=0.011),and C1q(OR=1.043,95%CI:1.020 to 1.066,P<0.001)were independent risk factors for ADP for lobectomy,and ADP(OR=0.241,95%CI:0.180 to 0.526,P=0.012)was an independent protective factor.ROC curve showed that plasma MMP-9(AUC=0.897,95%CI:0.859~0.927),C1q(AUC=0.849,95%CI:0.806~0.886),ADP(AUC=0.848,95%CI:0.805~0.885)level predicted the sensitivity and specificity of ADP in lobectomy were 82.58%,7

关 键 词：老年 肺叶切除术 术后谵妄 基质金属蛋白酶-9 补体1q 脂联素 

分 类 号：R619[医药卫生—外科学]