老年全身麻醉患者血清ADP、S-100β蛋白及HIF-1α水平与术后认知功能障碍的相关性分析

Correlation analysis of serum ADP,S-100βprotein and HIF-1αlevels and postoperative cognitive dysfunction in elderly patients with general anesthesia

目的探讨老年全身麻醉患者血清脂联素(ADP)、S-100β蛋白及缺氧诱导因子-1α(HIF-1α)水平与术后认知功能障碍(POCD)的相关性。方法选取南阳市中心医院2017年1月至2019年1月收治的159例接受手术治疗的老年患者,根据术后简易精神状态检查表(MMSE)评分分为POCD组(MMSE<27分,n=53)和非POCD组(MMSE≥27分,n=106),比较两组患者手术前后ADP、S-100β蛋白、HIF-1α水平变化,Pearson相关性分析MMSE评分与血清ADP、S-100β蛋白、HIF-1α水平的相关性,受试者操作特征(ROC)曲线分析血清ADP、S-100β蛋白、HIF-1α水平对老年全身麻醉POCD的预测价值。结果术后两组血清ADP水平和MMSE评分均明显降低,S-100β蛋白、HIF-1α水平明显提升,POCD组较非POCD组改变更明显(P<0.05);Pearson相关性分析显示,POCD组术后MMSE评分与血清ADP水平呈正相关,与S-100β蛋白、HIF-1α水平呈负相关(P<0.05);ROC曲线显示,ADP+S-100β蛋白+HIF-1α预测老年全身麻醉患者POCD的曲线下面积(AUC)、敏感度、特异度高于各指标单独预测。结论老年全身麻醉POCD患者血清ADP水平明显降低,S-100β蛋白和HIF-1α水平明显提升,与POCD发生密切相关,联合检测能提升POCD预测价值。

【Objective】To investigate the correlation between serum adiponectin(ADP),S-100βprotein and hypoxiainducible factor-1α(HIF-1α)levels in elderly patients with general anesthesia and postoperative cognitive dysfunction(POCD).【Methods】A total of 159 elderly patients undergoing surgical treatment in our hospital(January 2017 to January 2019)were selected and divided into the POCD group(MMSE<27 points,n=53)and non-POCD group(MMSE≥27 points,n=106),the levels of ADP,S-100βand HIF-1αwere compared between the two groups of patients before and after surgery.Pearson's correlation analysis was used to analyze the correlation between the MMSE score and the levels of serum ADP,S-100βand HIF-1α.The ROC curve was used to analyze the predictive value of serum ADP and S-100βprotein and HIF-1αlevels for POCD in elderly general anesthesia.【Results】The serum ADP levels and MMSE scores of the two groups of patients after the operation were significantly reduced,and the levels of S-100βprotein and HIF-1αwere significantly increased.The changes in the POCD group were more significant than those in the non-POCD group(P<0.05).Pearson correlation analysis showed that the postoperative MMSE score in the POCD group was positively correlated with serum ADP levels,and negatively correlated with S-100βprotein and HIF-1αlevels(P<0.05).ROC curve shows that the area under the curve(AUC),sensitivity,and specificity of ADP+S-100βprotein+HIF-1αin predicting POCD in elderly patients with general anesthesia are higher than those predicted by each index alone.【Conclusion】The serum ADP level of elderly patients with POCD under general anesthesia is significantly reduced,and the levels of S-100βprotein and HIF-1αare significantly increased,which are closely related to the occurrence of POCD.Combined detection can improve the predictive value of POCD.