妇科肿瘤患者腹腔镜术后谵妄预测的生物标志物分析

Biomarker analysis of prediction of delirium after laparoscopic surgery in gynecologic oncology

摘要:

：目的 探讨血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）与S-100β 蛋白对妇科肿瘤患 者腹腔镜术后谵妄（POD）的预测效果。方法 选取2015 年3 月-2016 年6 月该院收治的256 例行腹腔镜 全麻手术的妇科肿瘤患者为研究对象，根据术后状况分为POD 组（n =31）和非POD 组（n =225）。比较两 组的全麻前5 min、气管拔管即刻、出麻醉后监测治疗室（PACU）前、术后24、48 和72 h 的血清NGAL、 S-100β 蛋白、肌酐（Scr）和胱抑素C（Cys-c）的水平。采用受试者工作曲线下面积（AUC）来评价各指 标对POD 的预测效果。结果 两组全麻后的血清NGAL 与S-100β 的水平均明显高于全麻前，差异有统计 学意义（P <0.05）。POD 组的气管拔管即刻、出PACU 前、术后24 h 的血清NGAL 水平明显高于非POD 组， 差异有统计学意义（P <0.05）；POD 组的气管拔管即刻、出PACU 前、术后24、48 和72 h 的血清S-100β 水平明显高于非POD 组，差异有统计学意义（P <0.05）。全部患者术后均未出现急性肾损伤（AKI），两组不 同时间点的血清Scr 与Cys-C 水平比较，差异均无统计学意义（P >0.05）。气管拔管即刻、出PACU 前、术 后24 h 的血清NGAL 与S-100β 的AUC 分别为0.75、0.77、0.66 和0.85、0.83、0.80（P <0.05）。结论 血 清NGAL 和S-100β 水平可作为妇科肿瘤患者腹腔镜术后谵妄的早期预测指标，且后者的预测效果更加好， 尤其是气管拔管即刻与出PACU 前。

Abstract:

Objective To investigate the prognostic value of serum neutrophil gelatinase associated protein lipocalin (NGAL) and S-100β protein level on postoperative delirium (POD) in patient underwent gynecological laparoscopic tumor resection. Methods 256 patients underwent gynecological laparoscopic tumor resection from March 2015 to June 2016 were enrolled the study and divided into POD group (n = 31) and non-POD group (n = 225). Serum levels of NGAL, S-100β protein, creatinine (Scr) and cystatin C (Cys-c) were compared between the two groups at 5 min before anesthesia induction, immediately after extubation, during their stay in post anesthesia care unit (PACU) and at 24, 48, 72 h after operation. The area under receiver-operating characteristic curve (AUC) was performed to evaluate prognostic value of each index in POD. Results Serum levels of NGAL and S-100β after anesthesia in the two groups were all significantly higher than those before anesthesia (P < 0.05). Serum levels of NGAL in POD group immediately after extubation, during their stay in PACU and at 24 h after operation were significantly higher than those in non-POD group (P < 0.05). Serum levels of S-100β protein in POD group immediately after extubation, durng their stay in PACU and at 24, 48, 72 h after operation were significantly higherthan those in non-POD group (P < 0.05). There was no acute renal injury in all patients. There were no significant difference in serum levels of Scr and Cys-C between two groups at every time points (P > 0.05). The AUC of serum NGAL and S-100 protein immediately after extubation, durng their stay in PACU and at 24h after operation were 0.75, 0.77, 0.66 and 0.85, 0.83, 0.80 respectively (P < 0.05). Conclusions Serum NGAL and S-100β protein levels could be used as predictors of POD in patients undergoing gynecological laparoscopic tumor resection, and prediction effect of the latter was better, especially immediately after extubation and durng their stay in PACU.