老年患者术前中性粒细胞/淋巴细胞比值与术后谵妄的关系  

Relationships between preoperative neutrophil/lymphocyte ratio and postoperative delirium in elderly patients

作　　者：刘思羽 张梦雅 吴晓月 林旭[2] 王嘉涵 唐新慧 王菲[5] 王彬[2] 毕燕琳[2] Liu Siyu;Zhang Mengya;Wu Xiaoyue;Lin Xu;Wang Jiahan;Tang Xinhui;Wang Fei;Wang Bin;Bi Yanlin(School of Anesthesiology,Weifang Medical University,Weifang 261053,China;Department of Anesthesiology,Qingdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital)Qingdao 266071,China;Department of Anesthesiology,Dalian Medical University,Dalian 116044,China;Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Anesthesiology,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]潍坊医学院麻醉学院,潍坊261053 [2]康复大学青岛医院(青岛市市立医院)麻醉科,青岛266071 [3]大连医科大学麻醉学系,大连116044 [4]青岛大学附属青岛市市立医院麻醉科,青岛266071 [5]南京医科大学麻醉学院,南京211166

出　　处：《中华麻醉学杂志》2023年第8期925-930,共6页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(91849126)。

摘　　要：目的:评价老年患者术前中性粒细胞/淋巴细胞比值(NLR)与术后谵妄(POD)的关系。方法:择期蛛网膜下腔-硬膜外麻醉下行膝/髋关节置换术患者937例,术前1 d行简易智力状态检查量表(MMSE)评分且MMSE评分≥24分。术前抽取肘静脉血,计数中性粒细胞与淋巴细胞并计算比值。蛛网膜下腔-硬膜外麻醉穿刺成功后抽取脑脊液(CSF),采用ELISA法检测术前CSFβ淀粉样蛋白40(Aβ40)、β淀粉样蛋白42(Aβ42)、总tau蛋白(T-tau)和磷酸化tau蛋白(P-tau)水平。术后采用意识模糊评估(CAM)法评估POD的发生,采用记忆谵妄评定量表(MDAS)评估POD严重程度。采用logistic回归筛选POD的危险因素并分析CSF生物标志物的中介效应,采用敏感性分析检验logistic回归模型结果的稳定性。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)评价术前NLR预测POD的准确性。结果:共纳入853例患者,POD发生率为17.4%。logistic回归分析:校正多项混杂因素后,NLR(OR值1.141、95%CI 1.033~1.260、P=0.010)、CSF P-tau(OR值1.093、95%CI 1.076~1.110,P<0.001)和CSF T-tau(OR值1.003、95%CI 1.001~1.005、P<0.001)水平升高是POD的危险因素,CSF Aβ42(OR值0.998、95%CI 0.997~1.000、P=0.028)水平升高是POD的保护因素。中介效应分析:CSF T-tau和CSF P-tau在NLR与POD关系中存在中介效应,分别为0.0119和0.0200,总效应为0.0377,中介效应比率分别为46.1%和53.1%。ROC曲线显示,NLR及其联合CSF生物标志物预测POD的AUC分别为0.711和0.939。结论:术前NLR水平升高是膝/髋关节置换术老年患者POD的危险因素,NLR联合CSF生物标志物预测POD的准确性较高。CSF P-tau和T-tau在NLR与POD的关系中存在中介效应。Objective To evaluate the relationship between the preoperative neutrophil/lymphocyte ratio(NLR)and postoperative delirium(POD)in elderly patients.Methods Nine hundred and thirty-seven patients,undergoing elective knee or hip arthroplasty under combined spinal and epidural anesthesia,in whom Mini-Mental State Examination was completed at 1 day before operation,with Mini-Mental State Examination score≥24,were selected.Elbow venous blood samples were collected before surgery,neutrophils and lymphocytes were counted,and the ratio of neutrophils to lymphocytes was calculated.Cerebrospinal fluid(CSF)2 ml was extracted after successful spinal-epidural puncture for measurement of preoperative amyloid beta40(Aβ40),amyloid beta42(Aβ42),total Tau(T-tau),and phosphorylated Tau(P-tau)by enzyme-linked immunosorbent assay.POD was assessed by Confusion Assessment Method,and the severity of POD was assessed by the Memorial Delirium Assessment Scale.The logistic regression equation was used to identify the risk factors for POD,and the mediating effect of CSF biomarkers was analyzed.Sensitivity analysis was used to test the stability of the results.The receiver operating characteristic curve was introduced,and the area under the curve was calculated to evaluate the accuracy of preoperative NLR in predicting POD.Results A total of 853 patients were finally enrolled in this study,and 17.4%patients developed POD.Logistic regression analysis showed that the increased levels of NLR(OR 1.141,95%confidence interval[CI]1.033-1.260,P=0.010),P-tau in CSF(OR 1.093,95%CI 1.076-1.110,P<0.001)and T-tau in CSF(OR 1.003,95%CI 1.001-1.005,P<0.001)were risk factors for POD,while the increased level of Aβ42 in CSF(OR 0.998,95%CI 0.997-1.000,P=0.028)was a protective factor for POD after adjusting for multiple confounding factors.Analysis of mediating effect:T-tau and P-tau in CSF were the mediating factors in the relationship between NLR and POD with the mediating effects of 0.0119 and 0.0200 respectively,and the proportion of mediating effect w

关 键 词：老年人 白细胞 淋巴细胞 谵妄 

分 类 号：R614[医药卫生—麻醉学]