血清VCAM-1、PECAM-1水平与MMSE评分联合检测对老年全髋关节置换术患者术后谵妄的预测价值

doi:10.11958/20240396

天津医药 ›› 2024, Vol. 52 ›› Issue (10): 1046-1050.doi: 10.11958/20240396

血清VCAM-1、PECAM-1水平与MMSE评分联合检测对老年全髋关节置换术患者术后谵妄的预测价值

李繁(), 黎仕焕, 谢爽^△()

海南医学院第二附属医院麻醉科（邮编570311）

收稿日期:2024-04-01 修回日期:2024-04-15 出版日期:2024-10-15 发布日期:2024-10-14
通讯作者: △ E-mail：99945360@qq.com
作者简介:李繁（1983），女，副主任医师，主要从事麻醉学的临床与基础方面研究。E-mail：Liabc2021163@163.com
基金资助:
海南省卫生健康行业科研项目(22A200269)

Predictive value of combined detection of serum VCAM-1, PECAM-1 levels and MMSE score for postoperative delirium in elderly patients underwent total hip arthroplasty

LI Fan(), LI Shihuan, XIE Shuang^△()

Department of Anesthesia, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China

Received:2024-04-01 Revised:2024-04-15 Published:2024-10-15 Online:2024-10-14
Contact: △ E-mail：99945360@qq.com

李繁, 黎仕焕, 谢爽. 血清VCAM-1、PECAM-1水平与MMSE评分联合检测对老年全髋关节置换术患者术后谵妄的预测价值[J]. 天津医药, 2024, 52(10): 1046-1050.

LI Fan, LI Shihuan, XIE Shuang. Predictive value of combined detection of serum VCAM-1, PECAM-1 levels and MMSE score for postoperative delirium in elderly patients underwent total hip arthroplasty[J]. Tianjin Medical Journal, 2024, 52(10): 1046-1050.

摘要/Abstract

摘要：

目的探讨术前血清血管细胞黏附分子-1（VCAM-1）、血小板内皮细胞黏附分子-1（PECAM-1）水平与简易精神状态量表（MMSE）评分联合检测对老年全髋关节置换术（THA）患者术后谵妄（POD）的预测价值。方法选择住院并行手术治疗的髋部骨折老年患者200例作为研究对象，并根据术后3 d内是否发生POD分为POD组（44例）和非POD组（156例）。收集2组患者的临床资料，术前采用MMSE评估患者的认知状况，并检测术前、术后第1天和第3天血清VCAM-1、PECAM-1水平。对比2组患者上述指标的差异，并分析术前血清VCAM-1、PECAM-1水平与MMSE评分的相关性。应用多因素Logistic回归分析老年THA患者发生POD的影响因素。构建受试者工作特征（ROC）曲线评估术前血清VCAM-1水平、PECAM-1水平、MMSE评分单独及联合检测对老年THA患者并发POD的预测价值。结果 POD组年龄、医院焦虑抑郁量表评分、术中低血压发生率、术后住院时间明显高于或长于非POD组，MMSE评分低于非POD组（P<0.05）。POD组术前、术后第1天和术后第3天血清VCAM-1、PECAM-1水平升高，且高于非POD组（P<0.05）。老年THA患者术前血清VCAM-1、PECAM-1水平分别与MMSE评分呈负相关（r分别为-0.390、-0.501，均P<0.01）。术前血清VCAM-1和PECAM-1水平升高以及术后住院时间延长为老年THA患者发生POD的独立危险因素，MMSE评分升高为独立保护因素（P<0.05）。术前血清VCAM-1（AUC=0.793，95%CI：0.730~0.847）、PECAM-1（AUC=0.799，95%CI：0.736~0.852）及MMSE评分（AUC=0.805，95%CI：0.744~0.858）对THA患者发生POD均有较高的预测价值，三项指标联合预测的效能更高。结论血清VCAM-1、PECAM-1水平升高与老年THA患者认知功能受损有关，且均为老年THA患者发生POD的独立预测因子，术前检测以上指标可能对POD的早期防治具有重要价值。

关键词: 关节成形术, 置换, 髋, 谵妄, 术后认知并发症, 血管细胞黏附分子1, 血小板内皮细胞黏附分子1, 老年人, 简易智能状态量表

Abstract:

Objective To investigate the predictive value of combined detection of serum vascular cell adhesion molecule-1(VCAM-1), platelet endothelial cell adhesion molecule-1 (PECAM-1) levels and mini mental state examination (MMSE) score for postoperative delirium (POD) in elderly patients underwent total hip arthroplasty (THA). Methods A total of 200 elderly patients with hip fracture underwent surgical treatment were selected as the research objects. Patients were divided into the POD group (n=44) and the non-POD group (n=156) according to whether POD occurred within 3 days after operation. The clinical data of patients in the two groups were collected. The preoperative cognitive status was evaluated by MMSE, and serum levels of VCAM-1 and PECAM-1 were detected before operation and 1st and 3rd day after operation. The differences of the above indexes between the two groups were compared, and the correlation between preoperative serum VCAM-1, PECAM-1 levels and MMSE score were analyzed. Multivariate Logistic regression analysis was utilized to investigate influencing factors of POD in elderly patients underwent THA. A receiver operating characteristic (ROC) curve was constructed to assess the predictive value of preoperative serum levels of VCAM-1 and PECAM-1, as well as MMSE score, both individually and in combination for POD in elderly patients undergoing THA. Results The age, hospital anxiety and depression scale score, incidence of intraoperative hypotension and postoperative hospital stay were significantly higher or longer in the POD group than those in the non-POD group, and the MMSE score was lower than that in the non-POD group (P<0.05). The serum levels of VCAM-1 and PECAM-1 before operation, 1st and 3rd day after operation were increased in the POD group, and which were significantly higher than those in the non-POD group (P<0.05). The serum levels of VCAM-1 and PECAM-1 were significantly negatively correlated with MMSE score in elderly patients undergoing THA (r=-0.390, -0.501, P<0.01). The elevated serum levels of VCAM-1 and PECAM-1 before operation and prolonged postoperative hospital stay were independent risk factors for POD in elderly patients underwent THA, and the elevated value of MMSE score was independent protective factor (P<0.05). Preoperative serum VCAM-1 (AUC=0.793, 95%CI:0.730-0.847), PECAM-1 (AUC=0.799, 95%CI:0.736-0.852) and MMSE score (AUC=0.805, 95%CI: 0.744-0.858) showed high predictive value for POD in elderly patients underwent THA, and the combined detection of the three indicators had higher predictive efficiency. Conclusion The elevated serum levels of VCAM-1 and PECAM-1 are related to the impairment of cognitive function in elderly patients undergoing THA, and they are independent predictors for POD in elderly patients undergoing THA, thus may be helpful for early diagnosis and prevention of POD．

Key words: arthroplasty, replacement, hip, delirious speech, postoperative cognitive complications, vascular cell adhesion molecule-1, platelet endothelial cell adhesion molecule-1, aged, mini mental state examination score

中图分类号:

R687.42

图/表 5

参考文献 21

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组别		n	性别（男/女）		年龄/岁		BMI/（kg/m²）		教育年限/年	吸烟史（有/无）		饮酒史（有/无）		手术史（有/无）		全麻史（有/无）
非POD组		156	89/67		71.58±6.29		25.32±2.33		9.66±2.46	33/123		26/130		21/135		16/140
POD组		44	27/17		74.07±5.36		25.94±2.02		9.32±2.88	12/32		10/34		8/36		6/38
χ²或t			0.262		2.393^＊		1.604		0.783	0.737		0.854		0.617		0.400
组别	CCI评分/分			MMSE评分/分		HAD评分/分		ASA分级（Ⅰ/Ⅱ/Ⅲ）			术中低血压（有/无）		手术时间/min		术后住院时间/d
非POD组	2.0（1.0，2.0）			25.97±1.87		10.76±2.59		18/127/11			34/122		113.41±12.29		10.24±2.38
POD组	2.0（1.0，3.0）			24.00±1.40		11.75±3.19		5/33/6			18/26		116.75±12.64		11.84±2.48
Z、t或χ²	1.196			6.472^＊＊		2.133^＊		1.928			6.517^＊		1.582		3.908^＊＊

组别		n	性别（男/女）		年龄/岁		BMI/（kg/m²）		教育年限/年	吸烟史（有/无）		饮酒史（有/无）		手术史（有/无）		全麻史（有/无）
非POD组		156	89/67		71.58±6.29		25.32±2.33		9.66±2.46	33/123		26/130		21/135		16/140
POD组		44	27/17		74.07±5.36		25.94±2.02		9.32±2.88	12/32		10/34		8/36		6/38
χ²或t			0.262		2.393^＊		1.604		0.783	0.737		0.854		0.617		0.400
组别	CCI评分/分			MMSE评分/分		HAD评分/分		ASA分级（Ⅰ/Ⅱ/Ⅲ）			术中低血压（有/无）		手术时间/min		术后住院时间/d
非POD组	2.0（1.0，2.0）			25.97±1.87		10.76±2.59		18/127/11			34/122		113.41±12.29		10.24±2.38
POD组	2.0（1.0，3.0）			24.00±1.40		11.75±3.19		5/33/6			18/26		116.75±12.64		11.84±2.48
Z、t或χ²	1.196			6.472^＊＊		2.133^＊		1.928			6.517^＊		1.582		3.908^＊＊

组别	n	VCAM-1/（mg/L）			PECAM-1/（μg/L）
组别	n	术前	术后第1天	术后第3天	术前	术后第1天	术后第3天
非POD组	156	1.13±0.45	1.15±0.35	1.09±0.36	8.45±2.44	8.70±1.97	8.31±1.81
POD组	44	1.75±0.77^c	2.16±0.51^ac	2.35±0.50^abc	11.84±3.39^c	12.96±2.07^ac	14.31±1.15^abc
F_组间/F_时间/F_交互		194.655^＊＊/59.912^＊＊/75.130^＊＊			297.107^＊＊/13.900^＊＊/17.875^＊＊

组别	n	VCAM-1/（mg/L）			PECAM-1/（μg/L）
组别	n	术前	术后第1天	术后第3天	术前	术后第1天	术后第3天
非POD组	156	1.13±0.45	1.15±0.35	1.09±0.36	8.45±2.44	8.70±1.97	8.31±1.81
POD组	44	1.75±0.77^c	2.16±0.51^ac	2.35±0.50^abc	11.84±3.39^c	12.96±2.07^ac	14.31±1.15^abc
F_组间/F_时间/F_交互		194.655^＊＊/59.912^＊＊/75.130^＊＊			297.107^＊＊/13.900^＊＊/17.875^＊＊

影响因素	β	SE	Wald χ²	P	OR	95%CI
MMSE评分	-0.387	0.168	5.331	0.021	0.679	0.489~0.943
术前VCAM-1	1.136	0.375	9.182	0.002	3.113	1.494~6.490
术前PECAM-1	0.320	0.106	9.077	0.003	1.377	1.118~1.696
术后住院时间	0.287	0.094	9.369	0.002	1.333	1.109~1.601
常数项	0.408	5.036	0.007	0.935	1.504	-

血清VCAM-1、PECAM-1水平与MMSE评分联合检测对老年全髋关节置换术患者术后谵妄的预测价值

Predictive value of combined detection of serum VCAM-1, PECAM-1 levels and MMSE score for postoperative delirium in elderly patients underwent total hip arthroplasty

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指标	AUC	95%CI	截断值	敏感度/%	特异度/%	约登指数
VCAM-1	0.793	0.730~0.847	1.23 mg/L	79.55	70.51	0.501
PECAM-1	0.799	0.736~0.852	10.95 μg/L	63.64	86.54	0.502
MMSE评分	0.805	0.744~0.858	25分	72.73	70.51	0.432
三者联合	0.860	0.804~0.905	-	78.18	87.62	0.547

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