胰岛素样生长因子-1水平与老年腹部术后谵妄的相关性
摘要
目的探讨术前血清胰岛素样生长因子(IGF)-1的浓度水平与老年患者腹部手术后谵妄(PDD)发生的关系。方法选择择期开腹手术患者160例,年龄65～80岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级。记录患者围术期基本情况及并发症的发生。术后当日及术后1、2、3 d随访患者,根据意识混乱评估法(CAM)和谵妄分级量表(DRS-R98)判断患者POD及其严重程度,每日2次评定。根据患者是否发生POD分为POD组和对照组,用酶联免疫吸附试验(ELISA)检测血清中C-反应蛋白(CRP)、白细胞介素(IL)-6和IGF-1浓度水平。结果 160例患者中有41例发生POD,POD组CRP、IL-6浓度水平明显高于对照组(P<0.05)。IGF-1是POD发生的独立危险因素(P<0.05)。用IGF-1构建的ROC曲线得出,Youden指数为0.614时ROC曲线上的最佳界值52.94 ng/ml,对应切点的敏感性80.8%,特异性80.6%。两组比较POD严重程度差异无统计学意义(P>0.05)。结论 IGF-1是POD的独立危险因素,可作为老年患者腹部POD的预测因素之一。
引文
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2 杨娜瑜,姜丽华.老年患者术后谵妄研究进展[J].临床麻醉学杂志,2013;29(10):1039-40.
3 Escartin C,Boyer F,Bemelmans AP,et al.Emmanuel brouillet IGF-1 exacerbates the neuroxicity of the mitochondrial inhibitor 3NP inrats[J].Neurosci Lett,2007;425(3):167-72.
4 韩梅,郑珊珊,李东白,等.老年患者术后谵妄与术前焦虑的相关性研究[J].医学与哲学,2015;36(6):83-5.
5 朱莉,刘义树,沈怡,等.老年肿瘤患者全麻术后谵妄的危险因素[J].临床麻醉学杂志,2013;29(10):948-50.
6 张伟萍.脑梗死患者血清胰岛素样生长因子-1和C反应蛋白检测的临床意义[J].心脑血管病防治,2015;9(3):200-1.
7 Arai Y,Hirose N,Yamamura K,et al.Serum insulin-like growth factor-1 in centenarians:implications of IGF-1 as a rapid turnover protein[J].J Gerontol A Biol Sci Med Sci,2001;56(2):79-82.
8 文雯,迟猛,王国年.术后谵妄与神经递质[J].临床麻醉学杂志,2014;30(10):1037-40.
9 Xu Z,Dong Y,Wang XS,et al.Peripheral surgical wounding and age-dependent neuroinflammation in mice[J].PLoS One,2014;9(5):e96752.
10 Park SE,Dantzer R,Kelley KW,et al.Central administration of insulin-like growth factor-1 decreases depressive-like behavior and brain cytokine expression in mice[J].J Neuroinflamm,2011;8:12.
11 Wilson K,Broadhurst C,Diver M,et al.Plasma insulin growth factor-1 and incident delirium in older people[J].Int J Geriatr Psychiatry,2005;20(2):154-9.
12 Adamis D,Treloar A,Martin FC,et al.Apoe and cytokines as biological markers for recovery of prevalent delirium in elderly medicl inpatients[J].Int J Geriatr Psychiatry,2007;22(2):688-94.
13 Egberts A,Wijnbeld EH,Fekkes D,et al.Neopterin:a potential biomarker for delirium in elderly patients[J].Dement Geriatr Cogn Disord,2015;39(1-2):116-24.