老年患者术前血清β2微球蛋白浓度与术后谵妄的关系
Association between preoperative serum β2-microglobulin concentrations and postoperative delirium in elderly patients
王元龙 1贺倩 2化树慧 1徐钐凌 2孔荐 2巩红岩 2董瑞 2林亚男 2李传 2毕燕琳 2王彬 2林旭2
作者信息
- 1. 滨州医学院第二临床医学院,烟台 264003
- 2. 青岛市市立医院麻醉科,青岛 266071
- 折叠
摘要
目的 评价老年患者术前血清β2微球蛋白(β2MG)浓度与术后谵妄(POD)的关系.方法 基于围术期神经认知障碍和生物标志物生活方式队列,属于巢式病例对照研究,选取2021年5月至2022年11月在青岛市市立医院择期于脊椎-硬膜外麻醉下行膝或髋关节置换术患者,根据是否发生POD将患者分为POD组和非POD组.收集患者病例资料,分析组间差异;采用logistic回归筛选POD的危险因素;敏感性分析检验回归模型的稳定性;中介效应模型评估脑脊液(CSF)生物标志物在β2MG对POD影响的中介效应;绘制受试者工作特征曲线并计算曲线下面积评价术前β2MG浓度和CSF生物标志物浓度预测POD发生的准确性.结果 POD组57例,非POD组449例.logis-tic 回归分析在校正了年龄、性别、受教育程度、简易智力状态检查量表评分、高血压史、输液量等多个混杂因素后的结果表明:血清β2MG和CSF总tau蛋白(t-tau)浓度升高为POD发生的危险因素,CSF β淀粉样蛋白42浓度升高为POD发生的保护因素(P＜0.05);中介效应分析结果显示,血清β2MG浓度升高对POD的影响由t-tau部分介导;血清β2MG浓度和CSF生物标志物浓度曲线下面积为0.742.结论 老年患者术前血清β2MG浓度升高为POD的危险因素,可能由CSF t-tau部分介导.
Abstract
Objective To evaluate the association between preoperative serum β2-microglobulin(β2MG)concentrations and postoperative delirium(POD)in elderly patients.Methods The study select-ed patients who underwent knee or hip arthroplasty under spinal-epidural anesthesia on an elective basis at Qingdao Municipal Hospital from May 2021 to November 2022.The patients were divided into a POD group and a non-POD group based on the occurrence of POD.The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort,which was a nested case-control study.The study collected baseline data from two groups of patients and analyzed the differences between them.Logistic regression was used to identify the risk factors for POD.The stability of the regression model was tested using sensitivity analysis.The mediation model was used to examine whether cerebrospinal fluid(CSF)biomarkers mediated the relationship between β2MG and POD.The receiver operating characteristic curve was drawn and the area under the curve was calculated to evaluate the accuracy of preoperative β2MG concentrations and CSF biomarker concentration in predicting POD.Results There were 57 cases in POD group and 449 cases in non-POD group.The results of logistic regression analysis showed that the increased β2MG and CSF total tau protein(t-tau)concentrations were risk factors for POD,and the increased CSF β-amyloid 42 con-centration was a protective factor for POD after adjustment for multiple confounders such as age,gender,ed-ucation,Mini-Mental State Examination,history of hypertension and infusion volume(P＜0.05).The results of mediation analysis showed that the serum β2MG's effect on POD was partly mediated by t-tau(18.1％).The results of the receiver operating characteristic curve showed that the area under the curve of the β2MG concentration combined with the CSF biomarker concentration was 0.742.Conclusions Elevated preopera-tive serum β2 MG concentration is a risk factor for POD in elderly patients,and the relationship may be part-ly mediated by CSF t-tau.
关键词
老年人/β2微球蛋白/谵妄/手术后并发症Key words
Aged/Beta 2-microglobulin/Delirious speech/Postoperative complications引用本文复制引用
出版年
2024
NETL
NSTL
万方数据