老年患者术前免疫功能相关因子预测术后并发症的价值

Predictive value of preoperative immune-function related factors for postoperative complications in elderly patients

目的评价老年患者术前免疫功能相关因子对术后并发症的预测价值。方法选择2021年3—8月行择期手术老年患者386例,男212例,女174例,年龄65~90岁,BMI 18~30 kg/m^(2),ASAⅠ—Ⅳ级。麻醉诱导前抽取静脉血样,采用流式荧光检测技术检测自然杀伤细胞(NK)细胞、CD19^(+)、CD3^(+)、CD4^(+)、CD8^(+)、IFN、肿瘤坏死因子(TNF)、白细胞介素(IL)-6、IL-2、IL-4和IL-10并记录术后30 d内并发症发生情况(心血管系统、呼吸系统、泌尿系统、消化系统、血液系统、神经系统、切口相关并发症)。根据术后30 d是否发生并发症将患者分为两组:并发症组和无并发症组。采用单因素分析筛选术后并发症的相关因素,将P<0.05的相关因素纳入二元Logistic回归模型,分析老年患者术后并发症的独立危险因素。比较两组术前免疫功能指标,绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)和95%可信区间(CI),评价术前免疫功能相关因子对老年患者术后并发症的预测价值。结果本研究发生术后并发症86例(22.3%)。单因素结果显示:患者年龄增大、ASAⅢ—Ⅳ级、合并呼吸系统疾病及肾脏疾病、高CCI、术中出血量增多和手术时间延长与术后并发症增加有关(P<0.05)。二元Logistic回归结果显示:年龄增大(OR=1.063,95%CI 1.020~1.109,P<0.001)、高ASA分级(OR=2.700,95%CI 1.438~5.069,P=0.002)、合并呼吸系统疾病(OR=2.968,95%CI 1.245~7.075,P=0.014)和手术时间延长(OR=1.008,95%CI 1.004~1.012,P<0.001)是老年患者术后并发症的独立危险因素。CD8^(+)预测老年患者术后并发症的AUC为0.688(95%CI 0.534~0.841,P=0.03)。IL-6预测老年患者术后并发症的AUC为0.781(95%CI 0.649~0.912,P=0.001)。结论术前CD8^(+)和IL-6升高可预测老年患者术后并发症的发生。

Objective To investigate the value of preoperative immune-function related factors in predicting postoperative complications in elderly patients.Methods From March 2021 to August 2021,a total of 386 selected elderly patients,212 male and 174 females,aged 65-90 years,BMI 18-30 kg/m^(2),ASA physical statusⅠ-Ⅳwere included.Venous blood samples were taken before anesthesia induction,levels of nature killer(NK)cell,CD19^(+),CD3^(+),CD4^(+),CD8^(+),immunoreactive fibronectin(IFN),tumor necrosis factors(TNF),interleukin(IL)-6,IL-2,IL-4,and IL-10 were measured by flow fluorescence technology,and the complications(cardiovascular system complications,respiratory system complications,urinary system complications,digestive system complications,blood system complications,nervous system complications,incision-related complications)within 30 days after operation were recorded.According to the occurrence of postoperative complications within 30 days,the patients were divided into two groups:non-complications group and complication group.Univariate analysis was used to screen the related factors of postoperative complications.Those correlated with P<0.05 were included in a binary Logistic regression model to analyze independent risk factors for postoperative complications in the elderly patients.The preoperative immune function index was compared between the two groups,the receiver operating characteristic(ROC)curve was drawn to calculate the area under the curve(AUC)and 95%confidence interval(CI),the predictive value of preoperative immune function was then evaluated for postoperative complications in the elderly patients.Results In our study,86 patients(22.3%)had postoperative complications.The postoperative complications were associated with the older age,respiratory disease,kidney diseases,high ASA physical status,high CCI,increased blood loss and increased surgical time(P<0.05).As shown by the Logistic regression analysis,older age(OR=1.063,95%CI 1.020-1.109,P<0.001),ASAⅢ-Ⅳ(OR=2.700,95%CI 1.438-5.069,P=0.002),respiratory disease(OR=2.968,95%CI 1.245-7.075,P=0.014)and extended duration of surgery(OR=1.008,95%CI 1.004-1.012,P<0.001)were independent risk factors for postoperative complications.By receiver operating characteristic analysis,CD8^(+)cells and IL-6 predicted postoperative complications with area under the curve of 0.688(95%CI 0.534-0.841)and 0.781(95%CI 0.649-0.912),respectively.Conclusion Increased preoperative CD8^(+)and IL-6 levels have a predictive value for postoperative complications in the elderly patients.