术中rSO2联合血清CHI3L1、CXCL16对结直肠癌患者术后认知功能障碍的预测价值

Predictive value of intraoperative rSO2 combined with serum CHI3L1 and CXCL16 for postoperative cognitive impairment in patients with colorectal cancer

目的:探讨术中脑氧饱和度(rSO2)联合血清几丁质酶3类蛋白1(CHI3L1)、CXC型趋化因子配体16(CXCL16)对结直肠癌患者术后认知功能障碍(POCD)的预测价值。方法:选取2021年11月至2023年9月我院行结直肠癌术后发生POCD的83例患者作为研究组,另选取同期行结直肠癌术后无POCD的83例患者作为对照组。采用Spearman法分析血清CHI3L1、CXCL16表达水平与MMSE评分的相关性;采用受试者工作特征(ROC)曲线分析术中rSO2联合血清CHI3L1、CXCL16对结直肠癌患者术后POCD的预测价值。结果:研究组与对照组术后简易精神状态评价量表(MMSE)评分存在显著性差异(P<0.05);两组T0和T1时间点rSO2水平比较,差异无统计学意义(P>0.05),T2、T3、T4及T5时间点rSO2水平存在显著性差异(P<0.05),且研究组rSO2变化率高于对照组(P<0.05);研究组血清CHI3L1和CXCL16表达水平均高于对照组(P<0.05);血清CHI3L1、CXCL16表达水平及术中rSO2变化率均与MMSE评分呈负相关(P<0.05);血清CHI3L1、CXCL16水平及rSO2变化率单独预测结直肠癌患者术后POCD的曲线下面积(AUC)分别为0.790、0.754及0.870,而三者联合预测的AUC为0.944,优于各自单独预测(Z_(三者联合-CHI3L1)=4.742、Z_(三者联合-CXCL16)=5.081,Z_(三者联合-rSO2变化率)=2.986,P均<0.05)。结论:术中rSO2联合血清CHI3L1、CXCL16对结直肠癌患者术后POCD具有较高的预测效能。

Objective:To explore the predictive value of intraoperative cerebral oxygen saturation(rSO2)combined with serum chitinase-3-like protein 1(CHI3L1)and CXC-chemokine ligand 16(CXCL16)for postoperative cognitive dysfunction(POCD)in colorectal cancer patients.Methods:83 patients who developed POCD after colorectal cancer surgery in our hospital from November 2021 to September 2023 were selected as the study group,another 83 patients without POCD who underwent colorectal cancer surgery were as control group.Spearman method was applied to analyze the correlation between serum CHI3L1,CXCL16 expression levels and MMSE score;receiver operating characteristic(ROC)curve was applied to analyze the predictive value of intraoperative rSO2combined with serum CHI3L1 and CXCL16 for postoperative POCD in colorectal cancer patients.Results:There was statistically difference in the postoperative MMSE scores between the study group and the control group(P<0.05);there was no statistically difference in rSO2level between the two groups at T0 and T1 time points(P>0.05),while there was statistically difference in rSO2level at T2,T3,T4,and T5 time points(P<0.05),and the change rate of rSO2in the study group was higher than that in the control group(P<0.05);the expression levels of serum CHI3L1 and CXCL16 in the study group were higher than those in the control group(P<0.05);the expression levels of serum CHI3L1 and CXCL16,and the intraoperative change rate of rSO2were negatively correlated with MMSE score(P<0.05);the area under the curve(AUC)of serum CHI3L1,CXCL16 levels,and rSO2change rate alone for predicting postoperative POCD in colorectal cancer patients was 0.790,0.754,and 0.870,respectively,however,the AUC predicted by the combination of the three was 0.944,which was better than their individual predictions(Z_(combination)-CHI3L1=4.742,Z_(combination)-XCL16=5.081,Z_(combination)-rSO2change rate=2.986,P<0.05).Conclusion:The combination of intraoperative rSO2and serum CHI3L1 and CXCL16 expression have high predictive efficacy for postoperative POCD in colorectal cancer patients.