Correlation between ferroptosis and post operative cognitive dysfunction in elderly patients with fractures

doi:10.11958/20241526

Abstract

Abstract:

Objective To analyze the correlation between ferroptosis and post operative cognitive dysfunction (POCD) in elderly patients with fractures.Methods A total of 120 elderly patients with fracture were divided into the control group and the POCD group according to whether POCD occurred, with 60 cases in each group. Basic data of the two groups were collected. The levels of nerve injury indicators [brain myelin basic protein (MBP), glial fibrillary acidic protein (GFAP)], and fractures markers [glutathione peroxidase 4 (GPX4), cyclooxygenase 2 (COX2), long-chain acyl-CoA synthase 4 (ACSL4)] were detected by enzyme-linked immunosorbent assay at 6 h after surgery. Logistic regression was used to analyze risk factors of POCD in elderly patients with fracture. The correlations between MBP, GFAP and GPX4, COX2 and ACSL4 were analyzed by Pearson correlation analysis. Receiver operating characteristic (ROC) curves were used to analyze predictive values of MBP, GFAP, GPX4, COX2 and ACSL4 levels to POCD.Results The age, proportion of general anesthesia, anesthesia time, intraoperative blood loss and MBP, GFAP, COX2, ACSL4 levels were higher in the POCD group than those in the control group (P<0.05), while GPX4 was lower than that in the control group (P<0.05). The levels of MBP and GFAP were negatively correlated with levels of GPX4 in elderly patients with fractures, and positively correlated with levels of COX2 and ACSL4 (P<0.05). Advanced age, general anesthesia, long duration of anesthesia, increased levels of MBP, GFAP, COX2 and ACSL4, and decreased level of GPX4 were independent risk factors for POCD in elderly fracture patients (P<0.05). The critical values of GPX4, COX2 and ACSL4 for predicting POCD in elderly patients with fractures were GPX4≤23.05 μg/L, COX2≥20.35 μg/L and ACSL4≥237.85 μg/L, and the AUC were 0.869, 0.736 and 0.841. The sensitivity was 76.67%, 68.33% and 88.33%, and the specificity was 86.67%, 78.33% and 75.00%, respectively. The diagnostic efficacy of GFAP, COX2 and ACSL4 was higher than that of MBP and GFAP.Conclusion The incidence of POCD in elderly patients with fracture is associated with ferroptosis, and levels of GPX4, COX2 and ACSL4 have certain predictive value for the incidence of POCD after surgery in elderly patients with fracture.

Key words: fractures, post operative cognitive dysfunction, ferroptosis, aged, glutathione peroxidase 4, cyclooxygenase 2, acyl-CoA dehydrogenase, long-chain

CLC Number:

R614

Figures/Tables 6

References 22

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组别		n		男性				年龄/岁			BMI/（kg/m²）			吸烟史		饮酒史			骨质疏松
对照组		60		34（56.66）				65.85±4.57			22.31±2.46			22（36.67）		18（30.00）			32（53.33）
POCD组		60		35（58.33）				68.73±4.65			22.19±2.29			24（40.00）		21（35.00）			37（61.67）
χ²或Z				0.034				3.425^＊			0.280			0.141		0.342			0.853
组别			骨折位置												ASA分级
组别			四肢			髋部			脊柱			其他			Ⅰ级		Ⅱ级			Ⅲ级
对照组			22（36.67）			28（46.67）			5（8.33）			5（8.33）			20（33.33）		24（40.00）			16（26.67）
POCD组			21（35.00）			29（48.33）			7（11.67）			3（5.00）			18（30.00）		25（41.67）			17（28.33）
Z			0.086												0.358
组别	麻醉类型						麻醉时间/min			术中出血量/mL			术中使用右美托咪定					术中使用非甾体类抗炎药
组别	全身麻醉				硬膜外麻醉		麻醉时间/min			术中出血量/mL			术中使用右美托咪定					术中使用非甾体类抗炎药
对照组	27（45.00）				33（55.00）		207.53±22.85			185.33±17.58			28（46.67）					21（35.00）
POCD组	38（63.33）				22（36.67）		232.13±24.61			206.23±22.34			33（55.00）					28（46.67）
Z、χ²或t	4.062^＊						5.673^＊			5.696^＊			0.834					1.690

组别		n		男性				年龄/岁			BMI/（kg/m²）			吸烟史		饮酒史			骨质疏松
对照组		60		34（56.66）				65.85±4.57			22.31±2.46			22（36.67）		18（30.00）			32（53.33）
POCD组		60		35（58.33）				68.73±4.65			22.19±2.29			24（40.00）		21（35.00）			37（61.67）
χ²或Z				0.034				3.425^＊			0.280			0.141		0.342			0.853
组别			骨折位置												ASA分级
组别			四肢			髋部			脊柱			其他			Ⅰ级		Ⅱ级			Ⅲ级
对照组			22（36.67）			28（46.67）			5（8.33）			5（8.33）			20（33.33）		24（40.00）			16（26.67）
POCD组			21（35.00）			29（48.33）			7（11.67）			3（5.00）			18（30.00）		25（41.67）			17（28.33）
Z			0.086												0.358
组别	麻醉类型						麻醉时间/min			术中出血量/mL			术中使用右美托咪定					术中使用非甾体类抗炎药
组别	全身麻醉				硬膜外麻醉		麻醉时间/min			术中出血量/mL			术中使用右美托咪定					术中使用非甾体类抗炎药
对照组	27（45.00）				33（55.00）		207.53±22.85			185.33±17.58			28（46.67）					21（35.00）
POCD组	38（63.33）				22（36.67）		232.13±24.61			206.23±22.34			33（55.00）					28（46.67）
Z、χ²或t	4.062^＊						5.673^＊			5.696^＊			0.834					1.690

组别		MBP/（mg/L）		GFAP/（ng/L）
对照组		0.65±0.25		3.81±0.54
POCD组		0.84±0.31		4.23±0.67
t		3.634^＊		3.811^＊
组别	GPX4/（μg/L）		COX2/（μg/L）		ACSL4/（μg/L）
对照组	27.13±4.16		17.94±3.57		224.17±35.81
POCD组	20.69±3.85		21.03±4.03		276.03±41.29
t	8.781^＊		4.457^＊		7.350^＊

组别		MBP/（mg/L）		GFAP/（ng/L）
对照组		0.65±0.25		3.81±0.54
POCD组		0.84±0.31		4.23±0.67
t		3.634^＊		3.811^＊
组别	GPX4/（μg/L）		COX2/（μg/L）		ACSL4/（μg/L）
对照组	27.13±4.16		17.94±3.57		224.17±35.81
POCD组	20.69±3.85		21.03±4.03		276.03±41.29
t	8.781^＊		4.457^＊		7.350^＊

指标	GPX4	COX2	ACSL4
MBP	-0.485^＊	0.336^＊	0.428^＊
GFAP	-0.422^＊	0.288^＊	0.407^＊