老年病人术前外周炎症表型与术后谵妄的关系:基于炎症标志物的潜在类别分析  

Correlation between preoperative peripheral inflammation phenotypes and postoperative delirium in elderly patients:a latent class analysis based on inflammatory markers

作　　者：张跃 柳雯 周志强 ZHANG Yue;LIU Wen;ZHOU Zhiqiang(Department of Anesthesiology,Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Department of Anesthesiology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京大学医学院附属金陵医院麻醉科,江苏省南京市210002 [2]南京医科大学第二附属医院麻醉科,江苏省南京市210011

出　　处：《实用老年医学》2025年第3期236-240,共5页Practical Geriatrics

摘　　要：目的采用基于外周炎症标志物的潜在类别分析,评价老年病人术前炎症表型与术后谵妄(POD)的关系。方法选择拟在南京大学医学院附属金陵医院接受单侧全髋关节置换手术的老年病人240例。麻醉前取动脉血样,采用ELISA法检测血浆CRP、TNF-α、IL-1β、IL-8及IL-6水平。术后3 d内采用意识模糊评估法(CAM)评估POD发生情况,将病人分为POD组与非POD组。使用潜在类别分析,根据外周炎症标志物水平将病人分为低炎症表型组与高炎症表型组,并采用多因素logistic回归分析病人发生POD的独立危险因素,应用ROC曲线分析炎症表型对POD的预测价值。结果与非POD组比较,POD组病人血浆CRP、TNF-α、IL-1β及IL-6水平差异有统计学意义(P<0.05)。应用这4种炎症标记物进行潜在类别分析,将病人分为低炎症表型组与高炎症表型组。多因素logistic回归分析显示,高炎症表型(OR=12.15,95%CI:5.57~26.50,P<0.001)、年龄(OR=1.07,95%CI:1.01~1.14,P=0.034)是发生POD的独立危险因素。ROC曲线分析结果提示高炎症表型预测POD的AUC为0.779(95%CI:0.716~0.847)。结论术前高炎症状态对老年单侧全髋关节置换术病人发生POD具有较好的预测价值。Objective To evaluate the relationship between preoperative inflammatory status and postoperative delirium(POD)in the elderly patients using latent class analysis based on peripheral inflammatory markers.Methods A total of 240 elderly patients scheduled for unilateral total hip replacement at Affiliated Jinling Hospital,Medical School of Nanjing university were enrolled in this study.Arterial blood samples were collected before anesthesia,and the levels of C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α),interleukin-1β(IL-1β),IL-8 and IL-6 were detected using enzyme linked immunosorbent assay method.The incidence of POD was assessed using Confusion Assessment Method(CAM)within 3 days after operation,and the patients were divided into POD group and non-POD group.Latent class analysis was used to categorize the patients based on peripheral inflammatory markers.Multivariate logistic regression analysis was used to investigate the independent risk factors for POD,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of hyperinflammatory phenotype for POD in the elderly patients.Results The levels of CRP,TNF-α,IL-1β,and IL-6 showed significant differences between non-POD group and POD group(P<0.05).Latent class analysis using these four inflammatory markers classified the patients into hyperinflammatory or hypoinflammatory phenotypes.Logistic regression analysis showed that hyperinflammatory phenotype(OR=12.15,95%CI:5.57-26.5,P<0.001)and age(OR=1.07,95%CI:1.01-1.14,P=0.034)were the independent risk factors for POD.ROC curve analysis showed that the AUC of hyperinflammatory phenotype in predicting POD was 0.779(95%CI:0.716-0.847).Conclusions A preoperative high inflammatory state has a good predictive effect on the occurrence of POD in the elderly patients undergoing unilateral total hip arthroplasty.

关 键 词：外周炎症 术后谵妄 老年人 潜在类别分析 

分 类 号：R619[医药卫生—外科学]