外周血白细胞介素-6与老年半髋关节置换术后谵妄△

Significance of IL-6 for predicting postoperative delirium secondary to hip hemiarthroplasty in elderly

摘要:

[目的] 利用受试者工作特征 (receiver operating characteristic, ROC) 曲线评价外周血白细胞介素-6 (interleukin-6, IL-6) 对老年半髋关节置换术患者术后谵妄 (postoperative delirium, POD) 的预测价值。[方法] 选取 2019 年 1 月—2021 年 6 月在本院进行半髋关节置换术的老年患者。采用意识模糊评分法(confusion assessment method, CAM)评估术后 1 周内谵妄的发生情况。检测患者术前，术后第 1、3、5 和 7 d 的外周静脉血 IL-6 含量。采用 ROC 曲线评价 IL-6 对术后谵妄发生的预测价值。[结果]本研究共纳入 210 例患者，30 例发生了 POD，发生率为 14.29%。术前两组患者外周血 IL-6 含量的差异无统计学意义(P＞0.05)；术后第 1 d 和第 3 d POD 组外周血 IL-6 含量均显著高于非 POD 组(P＜0.05)；而术后第 5 和 7 d 时两组外周血 IL-6 含量的差异均无统计学意义 (P＞0.05)。ROC 曲线分析提示：术后第 1 d 和 3 d 时外周血 IL-6 含量预测术后谵妄的曲线下面积 (area under curve, AUC)分别为 0.81 和 0.88，具有预测价值。[结论]老年股骨颈骨折进行半髋关节置换术患者术后谵妄发生率为 14.29%，术后前 3 d 监测患者外周血 IL-6 含量对术后谵妄发生有较高的预测价值。

Abstract:

[Objective] To evaluate the role of peripheral blood interleukin-6 (IL-6) predicting postoperative delirium (POD) after hip hemiarthroplasty by receiver operating characteristic (ROC) curve in elderly. [Methods] The aged patients who underwent hip hemiarthro- plasty in our hospital from January 2019 to June 2021 were included into this study. Confusion assessment method (CAM) was used to evalu- ate whether or not POD happened within 1 week after operation. The levels of IL-6 in peripheral venous blood were measured before surgery and at 1, 3, 5 and 7 days postoperatively. ROC curve analysis was conducted to evaluate the predictive value of IL-6 for POD. [Results] Of the 210 patients enrolled in this study, 30 patients developed POD, with an incidence of 14.29%. There was no significant difference in pe- ripheral blood IL-6 content between the groups before operation (P＞0.05) . However, the POD group had significantly higher blood IL-6 lev- els than the non-POD group at 1 and 3 days postoperatively (P＜0.05), which became not statistically significant between the two groups at 5 and 7 days after surgery (P＞0.05) . ROC curve analysis indicated that the area under curve (AUC) of IL-6 in peripheral blood at 1 d and 3 d after surgery for predicting postoperative delirium was 0.81 and 0.88, respectively, which had predictive value. [Conclusion] The incidence of postoperative delirium in elderly patients with hip hemiarthroplasty for femoral neck fracture is 14.29%. Monitoring the level of IL-6 in pe- ripheral blood in the first 3 days after surgery has high predictive value for postoperative delirium.