血清LP-PLA2、S100B、炎性蛋白与ICU老年骨科术后患者谵妄发生及预后的关系分析

The correlations between serum LP-PLA2,S100B,inflammatory protein and delirium occurrence and prognosis in elderly patients with orthopedic surgery in ICU

目的探究血清脂蛋白相关磷脂酶A2(LP-PLA2)、S100B蛋白(S100B)、C反应蛋白(CRP)与重症加强护理病房(ICU)老年骨科患者术后谵妄(POD)发生及预后的关系。方法选取ICU老年骨科手术患者97例作为研究对象,根据术后48 h是否发生谵妄分为POD患者24例(观察组),术后未发生谵妄患者73例(对照组)。比较两组血清LP-PLA2、S100B、CRP水平,采用接收者操作特征(ROC)曲线及ROC曲线下面积(AUC)分析血清LP-PLA2、S100B、CRP预测POD发生的截断值、敏感度、特异度,比较观察组治疗前后血清LP-PLA2、S100B、CRP水平及不同血清水平患者临床疗效总评量表(CGI-SI)、谵妄严重程度(DRS)评分,采用Pearson分析血清LP-PLA2、S100B、CRP与CGI-SI、DRS评分的关系。结果观察组出术后恢复室前、术后24 h血清LP-PLA2、S100B、CRP水平高于对照组(P<0.05);预测POD发生的AUC:术后24 h CRP>术后24 h LP-PLA2>出术后恢复室前CRP>术后24 h S100B>出术后恢复室前LP-PLA2>出术后恢复室前S100B(P<0.05);术后24 h LP-PLA2、S100B、CRP联合预测POD的AUC大于任何单一指标(P<0.05);观察组治疗后血清LP-PLA2、S100B、CRP水平低于治疗前(P<0.05);血清LP-PLA2、S100B、CRP高表达者CGI-SI、DRS评分高于低表达者(P<0.05);血清LP-PLA2、S100B、CRP与CGI-SI、DRS评分呈正相关(P<0.05)。结论ICU老年骨科术后POD患者血清LP-PLA2、S100B、CRP呈高表达,可预测POD的发生风险,并与患者病情、预后有关。

Objective To investigate the correlations between serum lipoprotein-associated phospholipase A2(LP-PLA2),S100B protein(S100B),C-reactive protein(CRP)and the occurrence and prognosis of delirium(POD)in the elderly orthopaedic patients in intensive care unit(ICU).Methods Ninty-seven patients with elderly orthopedic surgery in ICU from March 2016 to September 2019 in our hospital were selected.According to whether or not delirium occurred 48 hours after surgery,24 patients were treated with delirium(observation group),and 73 patients without delirium after operation were enrolled in control group.Compare the serum LP-PLA2,S100B,and CRP levels in the two groups.Receiver operating characteristic(ROC)curve and area under ROC(AUC)were used to analyze the cutoff,sensitivity,and specificity of serum LP-PLA2,S100B,and CRP in predicting the occurrence of POD.Compare the serum LP-PLA2,S100B,and CRP levels,and the total clinical efficacy scale(CGI-SI)and delirium severity(DRS)score of patients with different serum levels in the observation group before and after treatment.The correlations between serum LP-PLA2,S100B,CRP and CGI-SI,DRS scores were analyzed using Pearson analysis.Results The levels of serum LP-PLA2,S100B,and CRP in the observation group were significantly higher than those in the control group be-fore and 24 hours after the recovery room(P<0.05).Predicted AUCs for POD were the best of 24 hours postoperative CRP,and followed with 24 hours postoperative LP-PLA2,CRP after operation and before recovery room,24 hours postoperative S100B,LP-PLA2 after operation and before recovery room,and S100B after operation and before recovery room.24 hours after operation,the AUC of LP-PLA2,S100B,and CRP combined to predict POD was significantly grea-ter than all single index(P<0.05).The levels of serum LP-PLA2,S100B,and CRP in the observation group were significantly lower than before treatment(P<0.05).The CGI-SI and DRS scores of patients with high expression of serum LP-PLA2,S100B,and CRP were significantly higher than those with low expression(P<0.05).Serum LP-PLA2,S100B,and CRP were positively correlated with CGI-SI and DRS scores(P<0.05).Conclusion Serum LP-PLA2,S100B,and CRP are highly expressed in elderly patients with POD in ICU,which can predict the risk of POD and is related to the patient's condition and prognosis.