血清磷酸化神经丝重亚单位水平与脓毒症休克患者并发谵妄的关系

Relationship between serum phosphorylated neurofilament heavy subunit level and concurrent delirium in patients with septic shock

目的探讨脓毒症休克患者血清磷酸化神经丝重亚单位(pNF-H)水平与谵妄发生的关系。方法选择海南医学院第二附属医院2020年1月至2022年3月收治的117例脓毒症休克患者。根据谵妄诊断标准将患者分为非谵妄组73例,谵妄组44例。采用单因素分析、二元logistic回归模型分析及受试者操作特征(ROC)曲线探讨脓毒症休克患者血清pNF-H水平与谵妄发生的关系。结果谵妄组序贯器官衰竭估计(SOFA)评分、机械通气占比、28 d病死率及血清pNF-H、白细胞介素-6(IL-6)高于非谵妄组,血清白蛋白水平低于非谵妄组(P<0.05)。经二元logistic回归模型分析,SOFA评分升高、机械通气及血清pNF-H、IL-6水平升高均为脓毒症休克患者谵妄发生的独立危险因素(P<0.05)。经ROC曲线分析pNF-H预测脓毒症休克患者谵妄发生的曲线下面积均高于IL-6和SOFA评分(P<0.05)。结论脓毒症休克患者血清pNF-H水平升高为谵妄发生的独立危险因素,可作为脓毒症休克患者谵妄的预测指标。

Objective To investigate the relationship between serum phosphorylated neurofilament heavy subunit(pNF-H)level in patients with septic shock and the occurrence of delirium.Methods A total of 117 patients with septic shock admitted to the Second Affiliated Hospital of Hainan Medical University from January 2020 to March 2022 were selected.According to delirium diagnostic criteria,patients were divided into the 73 cases in non-delirium group and 44 cases in delirium group.Univariate analysis,binary logistic regression model analysis,and receiver operating characteristic(ROC)curve were used to explore the relationship between serum pNF-H level in patients with septic shock and the occurrence of delirium.Results The sequential organ failure assessment(SOFA)score,the proportion of mechanical ventilation,28-day mortality,and serum levels of pNF-H and interleukin-6(IL-6)in the delirium group were higher than those in the non-delirium group,while serum albumin levels were lower than those in the non-delirium group(P<0.05).According to binary logistic regression model analysis,the elevated value of SOFA score,mechanical ventilation,and the elevated levels of serum pNF-H and IL-6 were independent risk factors for the occurrence of delirium in patients with septic shock(P<0.05).According to ROC curve analysis,the area under the curve of pNF-H in predicting the occurrence of delirium in patients with septic shock were higher than those of IL-6 and SOFA score(P<0.05).Conclusion The elevated serum pNF-H level is an independent risk factor for the occurrence of delirium,which can be used as a predictor of delirium in patients with septic shock.