摘要
目的探讨血浆瘦素浓度与老年全髋关节置换术后认知功能障碍的相关性。方法选取全身麻醉下的老年单侧全髋关节置换手术患者102例为病例组及同期102例健康体检的老年人为对照组,记录围手术期基础疾病、手术时间、术中失血量、阿托品用量及麻黄碱用量等资料,抽取对照组健康体检时和病例组拔除气管插管时的静脉血,采用ELISA法检测血浆瘦素浓度,在术前及术后第7天采用简易智力状态检查法评定认知功能。结果病例组血浆瘦素浓度(23.73±9.82)ng/ml较对照组(9.74±2.57)ng/ml显著升高,差异有统计学意义(P<0.01)。病例组术后认知功能障碍24例(23.53%)。术后认知功能障碍患者血浆瘦素浓度(33.82±13.71)ng/ml较非术后认知功能障碍患者(20.63±5.18)ng/ml显著升高,差异有统计学意义(P<0.01)。Logistic回归分析显示,血浆瘦素浓度是术后认知功能障碍的独立危险因素(OR=1.19,P<0.01)。ROC曲线分析显示,血浆瘦素浓度大于22.14ng/ml,预测术后认知功能障碍的灵敏度为79.17%,特异度为78.21%。结论老年全髋关节置换术后患者血浆瘦素浓度显著升高,临床检测该指标有助于早期判断术后认知功能障碍的发生。
Objective To discuss the correlation between plasma leptin concentration and postoperative cognitive dysfunction （POCD） in elderly patients undergoing total hip replacement. Methods 102 elderly patients undergoing total hip replacement under general anesthesia were chosen as case group, and 102 elderly healthy individuals from physical examination were selected as control group. Materials including basic diseases during perioperative period, time of operation, amount of intraoperative blood loss, dosage of at- ropine and ephedrine were recorded. Venous blood of control group was drawn at physical examination, and that of case group was drawn when tracheal intubation was removed. Plasma leptin concentration was measured using enzyme-linked irmnunosorbent assay. Cognitive function was assessed on the seventh day after operation and before operation using mini-mental state examination. Results Plasma leptin level was significantly higher in case group than in control group [ （23.73± 9.82ng/ml） vs. （9.74 ± 2.57ng/ml）, （ P 〈0.01）]. There were 24 cases （221.53%） suffered from POCD in this group. Plasma leptin level in patients with POCD was markedly higher than that in patients without POCD （33.82 ± 13.71ng/ml vs. 20.63 ± 5.18ng/ml, P 〈 0.01 ）. A multivariate logistic regression showed that plasma leptin level was an independent risk factor of POCD （OR = 1.19, P 〈 0.01 ）. A receiver operating characteristic curve analysis showed that plasma leptin level was more than 22.14ng/ml, predicted POCD with sensitivity of 79.17% and specificity of 78.21%. Conclusions Plasma leptin level is enhanced in elderly patients undergoing total hip replacement, and clinical determination of this biomarker is beneficial to early-identifica occurrence of POCD.
出处
《心脑血管病防治》
2013年第6期436-438,442,共4页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
关键词
瘦素
术后认知功能障碍
髋关节置换术
Leptin
Postoperative cognitive dysfunction
Total hip replacement
