老年微血管抑郁术后血清神经特异性烯醇化酶水平与谵妄的关系

Tengxian Guo, Zhenxing Liu, J. Qi, Zhen Wu
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摘要

微血管减压术(MVD)术后谵妄(POD)发生率高。神经特异性烯醇化酶(NSE)调节神经元的存活、分化和神经突再生。因此,我们调查并评估了MVD手术后循环NSE水平是否与POD相关。我们共招募了209名患者和209名年龄和性别匹配的健康对照。对电子病历进行回顾性分析,并测量手术前后患者血清及对照组血清中NSE水平。根据是否存在POD对患者进行分类。术后患者血清NSE水平明显高于术前水平。此外,POD患者术后血清NSE水平明显高于非POD患者。此外,NSE水平与术后谵妄的类型和严重程度无显著相关性。年龄(OR = 1.153, 95% CI = 1.040 ~ 1.277, p = 0.006)、血清NSE水平(OR = 1.326, 95% CI = 1.177 ~ 1.494, p < 0.001)和血清S100β水平(OR = 1.006, 95% CI = 1.000 ~ 1.012, p = 0.048)是预测POD的三个独立变量。血清S100β水平与血清NSE水平存在显著相关(t = 2.690, p = 0.008)。在精密度-召回曲线下面积方面,血清NSE水平的判别能力(AUC = 0.876, 95% CI = 0.829-0.924, p < 0.0001)与血清S100β水平的判别能力(AUC = 0.879, 95% CI = 0.825-0.933, p < 0.0001)接近,且显著高于年龄(AUC = 0.813, 95% CI = 0.755-0.871, p < 0.0001)。将这三个特征结合起来,产生了比单个效果显著的改善。血清中NSE水平是老年人群MVD手术后发生POD可能性的一个更强的指标。该因素的临床测定可能有助于根据临床表现区分MVD手术后存在POD风险的老年患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Relationship of Postoperative Serum Neuro-Specific Enolase Levels with Postoperative Delirium Occurring after Microvascular Depression Surgery in Older Patients
There is a high incidence of postoperative delirium (POD) following microvascular decompression (MVD) surgery. Neuronal survival, differentiation, and neurite regeneration are regulated by neuro-specific enolase (NSE). Therefore, we investigated and assessed whether circulating NSE levels are related to POD after MVD surgery. We recruited a total of 209 patients and 209 age- and gender-matched healthy controls. A retrospective review of electronic medical records was conducted, and serum NSE levels were measured in the serum of patients before and after surgery, as well as the serum of controls. Patients were categorized according to the presence of POD. Postoperative patient serum levels of NSE were significantly higher compared to preoperative levels. Additionally, postoperative serum NSE levels were remarkably higher in POD patients than non-POD patients. In addition, there was no significant correlation between NSE levels and the type and severity of postoperative delirium. Age (OR = 1.153, 95% CI = 1.040–1.277, p = 0.006), the levels of serum NSE (OR = 1.326, 95% CI = 1.177–1.494, p < 0.001), and the levels of serum S100β (OR = 1.006, 95% CI = 1.000–1.012, p = 0.048) were the three independent variables for predicting POD. A significant correlation existed between serum S100β levels and serum NSE levels (t = 2.690, p = 0.008). In terms of area under the precision–recall curve, the discriminatory ability of serum NSE levels (AUC = 0.876, 95% CI = 0.829–0.924, p < 0.0001) was close to that of the serum S100β level (AUC = 0.879, 95% CI = 0.825–0.933, p < 0.0001) and significantly higher than that of age (AUC = 0.813, 95% CI = 0.755–0.871, p < 0.0001). Combining all three features produced a dramatic improvement over individual effects. The NSE level in serum was a stronger indicator of the likelihood of POD after MVD surgery in the older population. The clinical determination of this factor might be useful for distinguishing older patients at risk of POD after MVD surgery on the basis of their clinical findings.
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