术前血清IL-17A、SUA及修正衰弱指数与妇科肿瘤患者腹腔镜术后谵妄的关系

Relationship between preoperative serum levels of IL⁃17A,SUA and modified frailties index and postoperative delirium in patients with gynecological tumors after laparoscopy

目的 探讨术前血清白细胞介素17(IL-17A)、血清尿酸(SUA)及修正衰弱指数与妇科肿瘤患者腹腔镜术后谵妄的关系。方法 选取2021年5月至2023年5月石家庄市妇幼保健院择期全麻下行腹腔镜妇科肿瘤切除术患者148例为研究对象,根据患者术后谵妄情况分为术后谵妄组(POD,45例),及非术后谵妄组(NPOD,103例),比较两组术前血清IL-17A、SUA及修正衰弱指数,分析其对POD的预测效能。结果 POD组年龄、苏醒时间、IL-17A、SUA、修正衰弱指数水平较NPOD组高,清蛋白水平较NPOD低,差异有统计学意义(t=9.411、19.818、6.264、6.218、28.617、9.470,P<0.05);Logistic多因素回归分析,年龄、苏醒时间、IL-17A、SUA、修正衰弱指数为术后谵妄的危险因素,清蛋白为术后谵妄的保护因素(P<0.05);ROC曲线结果显示,IL-17A、SUA、修正衰弱指数三者单独及联合检测预测妇科肿瘤患者腹腔镜POD的曲线下面积(AUC)分别为0.845、0.835、0.876、0.933,三者联合预测优于单一预测(P<0.05)。结论 POD患者IL-17A、SUA、修正衰弱指数水平均升高,且IL-17A、SUA、修正衰弱指数均为POD的相关危险因素,三者联合检测对妇科肿瘤患者腹腔镜POD具有较高的预测价值。

Objective To investigate the relationship between preoperative serum levels of IL⁃17A,SUA and modified frailties index and postoperative delirium in patients with gynecological tumors after laparoscopy.Methods A total of 148 patients who underwent laparoscopic gynecological tumor resection un⁃der elective general anesthesia at the Sixth Peoples Hospital of Shijiazhuang from May 2021 to May 2023 were selected for this study.The patients were divided into two groups based on postoperative delirium:the postoperative delirium group(POD,45 cases),and the non⁃postoperative delirium group(NPOD,103 cas⁃es).The preoperative serum levels of IL⁃17A,SUA and the modified frailty index were compared between the two groups to analyze their predictive efficacy for POD.Results The levels of age,recovery time,IL⁃17A,SUA and modified frailty index in the POD group were higher than those in the NPOD group.The difference was statistically significant(t=9.411,19.818,6.264,6.218,28.617,9.470,P<0.05).Logistic regression analysis showed that age,recovery time,IL⁃17A,SUA and modified frailty index were risk factors for postop⁃erative delirium,and albumin was a protective factor for postoperative delirium(P<0.05).The ROC curve re⁃sults showed that the area under the curve(AUC)of laparoscopic POD in patients with gynecological tumors predicted by IL⁃17A,SUA,and modified frailty index alone and in combination were 0.845,0.835,0.876,and 0.933.The combined prediction is better than the single prediction.Conclusion The levels of IL⁃17A,SUA,and the modified frailty index were all increased in POD patients.IL⁃17A,SUA,and the modified frail⁃ty index were identified as risk factors for POD.The combined detection of these three factors showed a high predictive value for laparoscopic POD in patients with gynecological cancer.