老年髋部骨折术后谵妄患者血清S100B蛋白和NSE水平的变化及临床意义

Changes of S100B Protein and Neuron-Specific Enolase Level and Their Clinical Significance in Elderly Patients with Postoperative Delirium after Hip Fracture Surgery

目的探讨老年髋部骨折术后谵妄患者血清S100B蛋白和神经元特异性烯醇化酶(NSE)水平的变化及临床意义。方法回顾性分析2016年5月—10月于北京积水潭医院收治的195例老年髋部骨折手术患者的临床资料,美国麻醉医师协会分级Ⅰ～Ⅲ。术后采用谵妄量表诊断术后谵妄,记录患者术后1～3 d术后谵妄发病情况,根据患者术后是否发生术后谵妄分为谵妄组(26例)和非谵妄组(169例),对术后谵妄组进行1∶1匹配作为谵妄组(26例)和非谵妄组(26例)。测定两组患者术前1 d、术后24 h、术后72 h血清S100B蛋白和NSE水平变化。结果谵妄组患者术后24 h S100B蛋白水平明显高于术前1 d水平,术后72 h的蛋白水平低于术前1 d,而非谵妄组术后24 h和术后72 h的蛋白水平与术前比较差异无统计学意义(P> 0. 05)。谵妄组术后24 h的血清S100B蛋白水平高于非谵妄组(P <0. 05),而术前1 d和术后72 h差异无统计学意义(P> 0. 05)。两组在组间、时点间比较差异有统计学意义(P <0. 05)。两组在组间·时点间交互作用比较差异无统计学意义(P> 0. 05)。两组患者术前1 d、术后24 h、术后72 h血清NSE水平的变化趋势相同,时点间差异无统计学意义(P> 0. 05)。两组在组间、时点间比较差异无统计学意义(P> 0. 05),在组间·时点间比较差异有统计学意义(P <0. 05)。结论老年髋部骨折术后谵妄患者血清中S100B蛋白水平表达增强。

Objective To investigate the changes of serum S100B protein and neuron-specific enolase(NSE)level and their clinical significance in elderly patients with postoperative delirium after hip fracture surgery.Methods The study retrospectively analyzed the data of195elderly patients American Society of AnesthesiologistsⅠ-Ⅲtreated with hip fracture surgery,from May2016to Oct.2016in Beijing Jishuitan Hospital.Postoperative delirium diagnosed by the confusion assessment method after operation,incidence of postoperative delirium recorded from first to third day after operation.The patients were divided into a delirium group(n=26)and a non-delirium group(n=169)according to whether postoperative delirium occurred.Postoperative delirium group was matched equally as delirium group(26cases)and non-delirium group(26cases).The serum S100B and NSE protein concentration was measured1day before operation,24h,and72h after operation.Results The24h postoperative protein levels of24h S100B in the delirium group was significantly higher than the1d preoperative level,and the72h postoperative protein levels of the non-delirium group was lower than1d preoperative level,while the protein levels of the non-delirium group at postoperative24h and72h were not statistically significant(P>0.05).The level of serum S100B in the delirium group was higher than that in the non-delirium group at24h after operation(P<0.05),while there was no significant difference between the levels of serum S100B at1day before operation and72h after operation(P>0.05).There were significant differences between groups and time points(P<0.05),and there was no significant difference between group·time point(P>0.05).The trend of serum NSE expression in the two groups was the same at1day before operation,24h and72h after operation.There was no significant difference between groups and time points of the two groups(P>0.05),and there was significant difference between group·time point interaction(P<0.05).Conclusion The serum S100B protein level in the elderly patients with postoperative delirium after hip fracture surgery is increased.