妇科肿瘤患者腹腔镜术后谵妄预测的生物标志物分析

Biomarker analysis of prediction of delirium after laparoscopic surgery in gynecologic oncology

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与S-100β蛋白对妇科肿瘤患者腹腔镜术后谵妄(POD)的预测效果。方法选取2015年3月-2016年6月该院收治的256例行腹腔镜全麻手术的妇科肿瘤患者为研究对象,根据术后状况分为POD组(n=31)和非POD组(n=225)。比较两组的全麻前5 min、气管拔管即刻、出麻醉后监测治疗室(PACU)前、术后24、48和72 h的血清NGAL、S-100β蛋白、肌酐(Scr)和胱抑素C(Cys-c)的水平。采用受试者工作曲线下面积(AUC)来评价各指标对POD的预测效果。结果两组全麻后的血清NGAL与S-100β的水平均明显高于全麻前,差异有统计学意义(P<0.05)。POD组的气管拔管即刻、出PACU前、术后24 h的血清NGAL水平明显高于非POD组,差异有统计学意义(P<0.05);POD组的气管拔管即刻、出PACU前、术后24、48和72 h的血清S-100β水平明显高于非POD组,差异有统计学意义(P<0.05)。全部患者术后均未出现急性肾损伤(AKI),两组不同时间点的血清Scr与Cys-C水平比较,差异均无统计学意义(P>0.05)。气管拔管即刻、出PACU前、术后24 h的血清NGAL与S-100β的AUC分别为0.75、0.77、0.66和0.85、0.83、0.80(P<0.05)。结论血清NGAL和S-100β水平可作为妇科肿瘤患者腹腔镜术后谵妄的早期预测指标,且后者的预测效果更加好,尤其是气管拔管即刻与出PACU前。

Objective To investigate the prognostic value of serum neutrophil gelatinase associated protein lipocalin （NGAL） and S-10013 protein level on postoperative delirium （POD） in patient underwent gynecological laparoscopic tumor resection. Methods 256 patients underwent gynecological laparoscopic tumor resection from March 2015 to June 2016 were enrolled the study and divided into POD group （n = 31） and non-POD group （n = 225）. Serum levels of NGAL, S-10013 protein, creatinine （Scr） and cystatin C （Cys-c） were compared between the two groups at 5 rain before anesthesia induction, immediately after extubation, during their stay in post anesthesia care unit （PACU） and at 24, 48, 72 h after operation. The area under receiver-operating characteristic curve （AUC） was performed to evaluate prognostic value of each index in POD. Results Serum levels of NGAL and S-10013 after anesthesia in the two groups were all significantly higher than those before anesthesia （P 〈 0.05）. Serum levels of NGAL in POD group immediately after extubation, during their stay in PACU and at 24 h after operation were significantly higher than those in non-POD group （P 〈 0.05）. Serum levels of S-10013 protein in POD group immediately after extubation, durng their stay in PACU and at 24, 48, 72 h after operation were significantly higher than those in non-POD group （P 〈 0.05）. There was no acute renal injury in all patients. There were no significant difference in serum levels of Scr and Cys-C between two groups at every time points （P 〉 0.05）. The AUC of serum NGAL and S-100 protein immediately after extubation, durng their stay in PACU and at 24h after operation were 0.75, 0.77, 0.66 and 0.85, 0.83, 0.80 respectively （P 〈 0.05）. Conclusions Serum NGAL and S-10013 protein levels could be used as predictors of POD in patients undergoing gynecological laparoscopic tumor resection, and prediction effect of the latter was better, especially immediately after extubation and durng their stay in PACU.