老年髋部骨折患者血清pNF-H、HMGB1表达水平及其对全麻术术后认知功能障碍的预测价值

Expression levels of serum pNF-H and HMGB1 in elderly patients with hip fractures and their predictive value for postoperative cognitive dysfunction after general anesthesia surgery

目的探讨老年髋部骨折患者血清神经丝蛋白H磷酸化亚型(pNF-H)、高迁移率族蛋白B1(HMGB1)表达水平及其对全麻术术后认知功能障碍(POCD)的预测价值。方法选择2022年3月—2023年3月于陆军军医大学附属第二医院收治的96例老年髋部骨折全麻术术后患者的病例资料进行分析,按是否发生POCD分为POCD组(n=30)和非POCD组(n=66)。检测并比较2组受试者血清pNF-H、HMGB1表达水平差异;采用Pearson相关性分析方法,分析老年髋部骨折全麻术术后患者的血清pNF-H、HMGB1水平与蒙特利尔认知评估量表(MoCA)评分的相关性;采用受试者工作特征(ROC)曲线分析血清pNF-H、HMGB1水平对老年髋部骨折全麻术患者POCD的预测价值。结果POCD组血清pNF-H、HMGB1表达水平均高于非POCD组(P<0.05),MoCA评分低于非POCD组(P<0.05)。二元多因素Logistic回归分析发现,血清pNF-H、HMGB1水平升高均为老年髋部骨折患者全麻术POCD的独立危险因素(P<0.05)。Pearson相关分析发现,血清pNF-H、HMGB1水平与MoCA评分呈负相关(P<0.05)。ROC曲线分析显示,血清pNF-H、HMGB1水平对老年髋部骨折患者全麻术POCD均有预测效能(P<0.05),其曲线下面积(AUC)分别为0.763、0.765。结论老年髋部骨折全麻术患者的血清pNF-H、HMGB1异常高表达与POCD的发生发展存在相关性,有望通过监测患者血清pNF-H、HMGB1水平预测患者术后认知功能。

Objective To explore the expression levels of serum phosphorylated high molecular weight neurofilament subunit(pNF-H)and high mobility group protein B1(HMGB1)in elderly patients with hip fractures and their predictive value for postoperative cognitive dysfunction(POCD)after general anesthesia surgery.Methods 96 elderly patients with hip fracture after general anesthesia surgery treated in Second Affiliated Hospital of Army Military Medical University from March 2022 to March 2023 were selected for analysis.According to whether POCD occurred,they were divided into POCD group(n=30)and non-POCD group(n=66).The expression levels of serum pNF-H and HMGB1 were detected and compared between the two groups.Pearson correlation analysis was used to analyze the correlation between serum pNF-H and HMGB1 levels and Montreal Cognitive Assessment Scale(MoCA)score in elderly patients with hip fractures after general anesthesia surgery.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the levels of serum pNF-H and HMGB1 for POCD in elderly patients with hip fractures undergoing general anesthesia.Results The levels of serum pNF-H and HMGB1 in the POCD group were higher than those in the non-POCD group(P<0.05),while MoCA score was lower than that in the non-POCD group(P<0.05).Binary Logistic regression analysis showed that high levels of serum pNF-H and HMGB1 were independent risk factors for POCD in elderly patients with hip fracture undergoing general anesthesia(P<0.05).Pearson correlation analysis found that the levels of serum pNF-H and HMGB1 were negatively correlated with MoCA score(P<0.05).ROC curve analysis showed that the levels of serum pNF-H and HMGB1 had predictive power for POCD in elderly hip fracture patients undergoing general anesthesia(P<0.05),and their areas under the curves(AUCs)were 0.763 and 0.765,respectively.Conclusion Abnormal high expressions of serum pNF-H and HMGB1 in elderly patients with hip fractures undergoing general anesthesia are correlated with the occurrence and development of POCD.It is expected to predict postoperative cognitive function of patients by means of monitoring the levels of serum pNF-H and HMGB1.