膝或髋关节置换术患者术前血清胆红素浓度与术后谵妄的关系  

Relationship between preoperative serum bilirubin concentration and postoperative delirium in patients undergoing knee or hip replacement

作　　者：化树慧 张梦雅 徐钐凌 杨云超 张浩然 李传 林亚男 董瑞[2] 巩红岩 林旭[2] 毕燕琳[2] 王彬[2] Hua Shuhui;Zhang Mengya;Xu Shanling;Yang Yunchao;Zhang Haoran;Li Chuan;Lin Yanan;Dong Rui;Gong Hongyan;Lin Xu;Bi Yanlin;Wang Bin(The Second Clinical Medical College of Binzhou Medical College,Yantai 264000,China;Department of Anesthesiology,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Anesthesiology,Weifang Medical College,Weifang 261053,China)

机构地区：[1]滨州医学院第二临床医学院,烟台264000 [2]青岛市市立医院麻醉科,青岛266071 [3]山东第二医科大学麻醉学院,潍坊261053

出　　处：《中华麻醉学杂志》2024年第3期286-291,共6页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(91849126)。

摘　　要：目的评价膝或髋关节置换术患者术前血清胆红素浓度与术后谵妄(POD)的关系。方法采用巢式病例对照研究设计,选取2020年8月至2023年10月间在青岛市市立医院拟行膝或髋关节置换术患者病历资料,根据是否发生POD分为POD组(n=77)和非POD组(n=336),收集病历资料,对可疑影响因素进行单因素分析,采用logistic回归法筛选POD的危险因素,分析中介效应,绘制受试者工作特征曲线,评价危险因素预测POD的准确性。结果与非POD组比较,POD组年龄、受教育时间、糖尿病史比率、MDAS评分、总胆红素浓度、直接胆红素浓度、间接胆红素浓度、Aβ42浓度、p-tau浓度、t-tau浓度、Aβ42/p-tau比值和Aβ42/t-tau比值差异有统计学意义(P<0.05)。logistic回归分析结果显示,术前血清总胆红素、直接胆红素和间接胆红素浓度高是POD的危险因素(P<0.05)。中介效应分析显示,血清总胆红素、直接胆红素和间接胆红素浓度高与POD的关系由脑脊液总tau蛋白浓度部分介导。总胆红素、直接胆红素和间接胆红素联合脑脊液生物标志物浓度预测POD的受试者工作特征曲线下面积为0.83(P<0.001)。结论术前总胆红素、直接胆红素和间接胆红素浓度升高是膝或髋关节置换术患者POD的危险因素。脑脊液t-tau浓度是血清总胆红素、直胆红素和间接胆红素浓度影响POD发生的中介变量。Objective To evaluate the relationship between preoperative serum bilirubin concentrations and postoperative delirium(POD)in the patients undergoing knee or hip replacement.Methods Medical records from 413 patients undergoing knee or hip arthroplasty were selected from August 2020 to October 2023 at Qingdao Municipal Hospital using a nested case-control design based on the PNDABLE study cohort.The patients were divided into POD group(n=77)and non-POD group(n=336)according to whether POD occurred.Univariate analysis was used to analyze the influencing factors.Logistic regression was used to identify the risk factors for POD.The significance of mediation effect was tested.The receiver operating characteristic curve was drawn to evaluate the accuracy of risk factors in predicting POD.Results There were significant differences in age,education time,ratio of diabetes history,Memorial Delirium Assessment Scale score,total bilirubin concentration,direct bilirubin concentration,indirect bilirubin concentration,Aβ42 concentration,p-tau concentration,t-tau concentration,Aβ42/p-tau ratio and Aβ42/t-tau ratio between POD group and non-POD group(P<0.05).The results of logistic regression analysis showed that preoperative serum total bilirubin,direct bilirubin and indirect bilirubin were risk factors for POD(P<0.05).The results of mediation effects showed that the concentration of total tau protein in CSF partly mediated the relationship between high serum total bilirubin,direct bilirubin and indirect bilirubin concentrations and POD.The area under the receiver operating characteristic curve of total bilirubin,direct bilirubin and indirect bilirubin combined with CSF biomarker concentrations in predicting POD was 0.83(P<0.001).Conclusions Preoperative elevated concentrations of total bilirubin,direct bilirubin and indirect bilirubin are risk factors for POD in the patients undergoing knee or hip replacement.CSF t-tau concentration has a partly mediating role in the association between serum total bilirubin,direct bilirubin

关 键 词：关节成形术 置换 膝 关节成形术 置换 髋 胆红素 手术后并发症 谵妄 

分 类 号：R614[医药卫生—麻醉学]