老年患者术前脑损伤程度与术后谵妄的关系:基于脑损伤标志物的潜在类别分析  

Relationship between severity of preoperative brain injury and postoperative delirium in elderly patients:a latent class analysis of markers of brain injury

作　　者：王雷原 胡小义 王迪 纪木火 夏德国[3] Wang Leiyuan;Hu Xiaoyi;Wang Di;Ji Muhuo;Xia Deguo(The Second Clinical College of Nanjing Medical University,Nanjing 211166,China;Department of Anesthesiology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Anesthesiology,Northern Jiangsu People′s Hospital,Yangzhou 225001,China)

机构地区：[1]南京医科大学第二临床医学院,南京211166 [2]南京医科大学第二附属医院麻醉科,南京210009 [3]江苏省苏北人民医院麻醉科,扬州225001

出　　处：《中华麻醉学杂志》2024年第3期267-271,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(81971892,82172131,82372182)。

摘　　要：目的采用基于脑损伤标志物的潜在类别分析,评价老年患者术前脑损伤程度与术后谵妄(POD)的关系。方法选择拟行单侧全髋关节置换术老年患者131例,年龄65~84岁,BMI 18~28 kg/m2,ASA分级Ⅰ-Ⅲ级。术前通过简易智力状态检查量表(MMSE)评估认知功能,麻醉前取动脉血样,采用ELISA法检测血浆脑源性神经营养因子(BDNF)、诱导型一氧化氮合酶(iNOS)、前列腺素E2(PGE2)、中枢神经特异性蛋白(S100β)、神经胶质酸性蛋白(GFAP)、神经纤维丝轻链(NFL)、基质金属蛋白酶(MMP9)、成纤维细胞生长因子23(FGF-23)、补体3(C3)、补体3a(C3a)、补体5a(C5a)及鸢尾素(Irisin)浓度。术后3 d内采用意识模糊评估法(CAM)评估POD发生情况,将患者分为POD组与非POD组。使用潜在类别分析,根据脑损伤标志物水平将患者分为不同损伤程度亚型,并用logistic多因素回归分析患者POD的独立危险因素。结果与非POD组比较,POD组患者血浆NFL、GFAP、S100β和PGE2浓度差异有统计学意义(P<0.05)。应用这4种脑损伤标记物进行潜在类别分析,将患者分为高脑损伤程度(91.51%)和低脑损伤程度(8.49%)。logistic多因素回归结果显示,脑损伤程度亚型(OR=8.31,95%CI 1.77~38.90,P=0.007)、年龄(OR=1.14,95%CI 1.03~1.24,P=0.007)及血浆Irisin浓度(OR=0.99,95%CI 0.98~0.99,P=0.027)是POD的独立危险因素。结论术前脑损伤程度较高是老年患者POD的独立危险因素。Objective To evaluate the relationship between the severity of preoperative brain injury and postoperative delirium(POD)in elderly patients using latent class analysis based on markers of brain injury.Methods One hundred and thirty-one American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients,aged 65-84 yr,with a body mass index of 18-28 kg/m2,scheduled for elective unilateral total hip arthroplasty in our hospital,were selected.Cognitive function was assessed using the Mini-Mental State Examination before surgery.Arterial blood samples were collected before anesthesia to measure the plasma concentrations of brain-derived neurotrophic factor,inducible nitric oxide synthase,prostaglandin E2,central nervous system-specific protein(S100β),glial fibrillary acidic protein,neurofilament light chain,matrix metalloproteinase-9,fibroblast growth factor 23,complement 3,complement 3a,complement 5a and irisin using enzyme-linked immunosorbent assay.POD was evaluated using the Confusion Assessment Method within 3 days after operation,and the patients were divided into POD group and non-POD group.The patients were divided into different injury severity subtypes based on the levels of brain injury markers using latent class analysis,and logistic multivariate regression was used to analyze the independent risk factors for POD.Results Compared with non-POD group,the concentrations of neurofilament light chain,glial fibrillary acidic protein,S100βand prostaglandin E2 were significantly different in POD group(P<0.05).Using these four brain injury markers for latent class analysis,patients were divided into a high severity of brain injury group(91.51%)and a low severity of brain injury group(8.49%).The results of logistic multivariate regression analysis showed that subtypes of brain injury(OR=8.31,95%confidence interval[CI]1.77-38.90,P=0.007),age(OR=1.14,95%CI 1.03-1.24,P=0.007),and plasma irisin concentrations(OR=0.99,95%CI 0.98-0.99,P=0.027)were independent risk factors for POD.Conclusions Higher sever

关 键 词：脑损伤 术后谵妄 认知功能 老年人 潜在类别分析 

分 类 号：R614[医药卫生—麻醉学]