NLR、Aβ、IGF-1对老年结直肠癌根治术患者术后早期认知功能的预测价值

The predictive value of NLR,Aβand IGF⁃1 on early postoperative cognitive function in elderly patients undergoing radical resection of colorectal cancer

目的 探讨血清中性粒细胞与淋巴细胞比值(NLR)、β-淀粉样蛋白(Aβ)、胰岛素样生长因子-1(IGF-1)对老年结直肠癌根治术患者术后认知功能障碍(POCD)的预测价值。方法 分析2019年1月至2022年12月合肥市第八人民医院收治的122例行腹腔镜结直肠癌根治术患者的临床资料,术后使用简易精神状态检查表(MMSE)对患者认知功能进行评估,将患者分为POCD组及非POCD组。对两组术后24 h内血清NLR、Aβ、IGF-1水平进行比较,二元Logistic回归分析患者术后发生POCD的影响因素,受试者工作曲线(ROC)分析血清NLR、Aβ、IGF-1水平对老年结直肠癌根治术患者发生POCD的预测价值。结果 术后7 d共有54例患者出现POCD。POCD组NLR及Aβ水平高于非POCD组,IGF-1水平低于非POCD组,差异均有统计学意义(t=5.894、6.108、6.481,P<0.05);多元Logistic回归分析显示,手术时间长、NLR及Aβ上升、IGF-1下降是患者术后发生POCD的危险因素(P<0.05),受教育年限高是患者术后发生POCD的保护因素(P<0.05);ROC曲线结果显示,血清NLR、Aβ、IGF-1单独及联合检测预测老年结直肠癌根治术患者发生POCD的曲线下面积分别为0.774、0.779、0.794、0.910,联合检测优于单一检测(P<0.05)。结论 血清NLR、Aβ、IGF-1水平异常可能与老年结直肠癌根治术患者发生POCD有关,通过三者联合检测对预测POCD发生具有较好的应用价值。

Objective To investigate the predictive value of serum neutrophil/lympho cyte ratio(NLR),amyloidβ-protein(Aβ)and insulin-like growth factor-1(IGF-1)on postoperative cognitive dysfunc-tion(POCD)in elderly patients undergoing radical resection of colorectal cancer.Methods The clinical data of 122 patients who underwent laparoscopic radical resection for colorectal cancer at Hefei Eighth People’s Hospital from January 2019 to December 2022 were retrospectively analyzed.The cognitive function of these patients was evaluated using mini-mental state examination(MMSE)after the operation.The patients were then divided into two groups:those with POCD and those without(non-POCD).The levels of serum NLR,Aβand IGF-1 within 24 hours after the operation were compared between the two groups.The influencing fac-tors of POCD after operation were analyzed using binary logistic regression.The receiver operating curve(ROC)was used to evaluate the predictive value of serum NLR,Aβand IGF-1 levels for POCD in elderly pa-tients undergoing radical resection for colorectal cancer.Results POCD was observed in 54 patients 7 days af-ter their operation.The levels of NLR and Aβin the POCD group were higher than those in the non-POCD group,while the level of IGF-1 was lower than in the non-POCD group,the differences were statistically sig-nificant(t=5.894,6.108,6.481,P<0.05).Multivariate logistic regression analysis showed that long operation time,increased NLR and Aβ,levels,and decreased IGF-1 were risk factors for postoperative POCD(P<0.05).Additionally,higher years of education were shown to be protective factors against postoperative POCD(P<0.05).ROC curve results showed that the area under the curve of serum NLR,Aβ,IGF-1 alone and com-bined detection in predicting POCD in elderly patients undergoing radical resection of colorectal cancer were 0.774,0.779,0.794 and 0.910,respectively.The combined detection was better than single detection(P<0.05).Conclusion The abnormal levels of serum NLR,Aβ,and IGF-1 may be related to the occurrence of POCD in elderly patients undergoing radical resection of colorectal cancer.The combined detection of these three markers has a significant application value in predicting the occurrence of POCD.