术前修正衰弱指数联合血清PGE_(2)、IL-17A预测老年髋关节置换术患者术后谵妄的临床研究

Clinical Study of Preoperative Modified Frailty Index Combined with Serum PGE_(2) and IL-17A to Predict Postoperative Delirium in Elderly Patients with Hip Replacement

目的:探讨术前修正衰弱指数(mFI)联合血清前列腺素E_(2)(PGE_(2))、白细胞介素-17A(IL-17A)预测老年髋关节置换术患者术后谵妄(POD)的临床研究。方法:选取2020年1月~2022年7月四川大学华西医院收治的276例老年髋关节置换术患者,根据是否发生POD分为POD组和非POD组。计算术前mFI,采用酶联免疫吸附法检测血清PGE_(2)、IL-17A水平。分析老年髋关节置换术患者POD的影响因素,采用受试者工作特征(ROC)曲线分析mFI和血清PGE_(2)、IL-17A水平对老年髋关节置换术患者POD的预测价值。结果:276例老年髋关节置换术患者POD发生率为17.03%(47/276)。与非POD组比较,POD组mFI和血清PGE_(2)、IL-17A水平升高(P<0.05)。多因素Logistic回归分析显示,年龄、糖尿病、脑卒中、mFI、PGE_(2)、IL-17A为老年髋关节置换术患者POD的独立危险因素(P<0.05)。ROC曲线分析显示,mFI联合血清PGE_(2)、IL-17A预测老年髋关节置换术患者POD的曲线下面积(AUC)大于mFI、PGE_(2)、IL-17A单独预测(P<0.05)。结论:mFI和血清PGE_(2)、IL-17A水平升高与老年髋关节置换术患者POD独立相关,mFI联合血清PGE_(2)、IL-17A预测老年髋关节置换术患者POD的价值较高,可能成为老年髋关节置换术患者POD的辅助预测指标。

Objective:To investigate the clinical study of preoperative modified frailty index(mFI)combined with serum prostaglandin E_(2)(PGE_(2))and interleukin-17A(IL-17A)to predict postoperative delirium(POD)in elderly patients with hip replacement.Methods:276 elderly patients with hip replacement who were admitted to West China Hospital of Sichuan University from January 2020 to July 2022 were selected,and they were divided into POD group and non-POD group according to the occurrence of POD.Preoperative mFI was calculated,and serum PGE_(2) and IL-17A levels were detected by enzyme-linked immunosorbent assay.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of mFI,serum PGE,and IL-17A levels on POD in elderly patients with hip replacement.Multivariate Logistic regression was used to analyze the influencing factors of POD in elderly patients with hip replacement.Results:The incidence of POD in 276 elderly patients with hip replacement was 17.03%(47/276).Compared with non-POD group,the mFI,serum PGE_(2) and IL-17A levels in the POD group were increased(P<0.05).Multivariate Logistic regression analysis showed that age,diabetes,stroke,mFI,PGE_(2) and IL-17A were independent risk factors for POD in elderly patients with hip replacement(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of mFI combined with serum PGE_(2) and IL-17A predicted POD in elderly patients with hip replacement was greater than mFI,PGE_(2),and IL-17A predicted individually(P<0.05).Conclusion:Elevated mFI and serum PGE_(2) and IL-17A levels are independently associated with POD in elderly patients with hip replacement.The mFI combined with serum PGE_(2) and IL-17A is of high value in predicting POD in elderly patients with hip replacement,and which may be an auxiliary predictor of POD in elderly patients with hip replacement.