老年患者术前血清β_(2)微球蛋白浓度与术后谵妄的关系

Association between preoperative serum β_(2)-microglobulin concentrations and postoperative delirium in elderly patients

目的评价老年患者术前血清β_(2)微球蛋白(β_(2)MG)浓度与术后谵妄(POD)的关系。方法基于围术期神经认知障碍和生物标志物生活方式队列,属于巢式病例对照研究,选取2021年5月至2022年11月在青岛市市立医院择期于脊椎-硬膜外麻醉下行膝或髋关节置换术患者,根据是否发生POD将患者分为POD组和非POD组。收集患者病例资料,分析组间差异;采用logistic回归筛选POD的危险因素;敏感性分析检验回归模型的稳定性;中介效应模型评估脑脊液(CSF)生物标志物在β_(2)MG对POD影响的中介效应;绘制受试者工作特征曲线并计算曲线下面积评价术前β_(2)MG浓度和CSF生物标志物浓度预测POD发生的准确性。结果POD组57例,非POD组449例。logistic回归分析在校正了年龄、性别、受教育程度、简易智力状态检查量表评分、高血压史、输液量等多个混杂因素后的结果表明:血清β_(2)MG和CSF总tau蛋白(t-tau)浓度升高为POD发生的危险因素,CSFβ淀粉样蛋白42浓度升高为POD发生的保护因素(P<0.05);中介效应分析结果显示,血清β_(2)MG浓度升高对POD的影响由t-tau部分介导;血清β_(2)MG浓度和CSF生物标志物浓度曲线下面积为0.742。结论老年患者术前血清β_(2)MG浓度升高为POD的危险因素,可能由CSF t-tau部分介导。

Objective To evaluate the association between preoperative serum β_(2)-microglobulin(β_(2)MG)concentrations and postoperative delirium(POD)in elderly patients.Methods The study selected patients who underwent knee or hip arthroplasty under spinal-epidural anesthesia on an elective basis at Qingdao Municipal Hospital from May 2021 to November 2022.The patients were divided into a POD group and a non-POD group based on the occurrence of POD.The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort,which was a nested case-control study.The study collected baseline data from two groups of patients and analyzed the differences between them.Logistic regression was used to identify the risk factors for POD.The stability of the regression model was tested using sensitivity analysis.The mediation model was used to examine whether cerebrospinal fluid(CSF)biomarkers mediated the relationship between β_(2)MG and POD.The receiver operating characteristic curve was drawn and the area under the curve was calculated to evaluate the accuracy of preoperative β_(2)MG concentrations and CSF biomarker concentration in predicting POD.Results There were 57 cases in POD group and 449 cases in non-POD group.The results of logistic regression analysis showed that the increased β_(2)MG and CSF total tau protein(t-tau)concentrations were risk factors for POD,and the increased CSFβ-amyloid 42 concentration was a protective factor for POD after adjustment for multiple confounders such as age,gender,education,Mini-Mental State Examination,history of hypertension and infusion volume(P<0.05).The results of mediation analysis showed that the serum β_(2)MG′s effect on POD was partly mediated by t-tau(18.1%).The results of the receiver operating characteristic curve showed that the area under the curve of the β_(2)MG concentration combined with the CSF biomarker concentration was 0.742.Conclusions Elevated preoperative serum β_(2)MG concentration is a risk factor for POD in elderly patients,and the relationship may be partly mediated by CSF t-tau.