血浆胶质纤维酸性蛋白浓度对老年腹部手术后谵妄的预测价值

目的：探讨血浆胶质纤维酸性蛋白（GFAP）浓度对老年腹部手术术后谵妄（PD）的预测价值。方法选取全身麻醉下腹部手术治疗的老年患者（病例组）及同期健康体检老年人（对照组）各212例，采用ELISA法检测对照组体检时和病例组患者麻醉结束时、离开麻醉后恢复室（PACU）时、术后24、72h时血浆GFAP浓度，分析其对老年腹部手术PD的预测价值。结果病例组麻醉结束时、离开PACU时、术后24、72h时血浆GFAP浓度均较对照组显著升高（均P＜0.01）。logistic回归分析显示，麻醉结束时血浆GFAP浓度（OR=1.361,95%CI=1.125-2.109，P＜0.01）和年龄（OR=1.743,95%CI=1.242-3.352，P＜0.01）是老年腹部手术患者PD发生的独立危险因素。ROC曲线分析显示，麻醉结束时血浆GFAP浓度预测PD发生有显著预测价值（曲线下面积=0.872,95%CI=0.820-0.914，P＜0.01），且判定血浆GFAP浓度＞19.9pg/ml对预测PD发生的灵敏度为75.0%、特异度80.2%。麻醉结束时血浆GFAP浓度的曲线下面积与离开PACU时和术后24h血浆GFAP浓度的曲线下面积的差异均无统计学意义（均P＞0.05），而显著大于术后72h血浆GFAP浓度的曲线下面积（P＜0.01）。结论老年腹部手术PD患者血浆GFAP浓度明显升高，检测血浆GFAP有助于早期判断PD的发生。

Predictive value of plasma glial fibrillary acidic protein concentration for postoperative delirium in elderly patients undergoing abdominal operation

Objective To assess the predictive value of plasma glial fibril ary acidic protein（GFAP） concentration for post-operative delirium （PD） in elderly patients undergoing abdominal operation. Methods Two hundred and twelve consecutive el-derly patients undergoing abdominal operation under general anesthesia（case group） and 212 elderly healthy individuals （control group） were enrolled into this study. Plasma GFAP concentrations of case group at the end of anesthesia （T1）, at the departure from post anesthesia care unit（T2）, and at 24 and 72 h after operation（T3 and T4） and that of control group on health check- up were measured by enzyme- linked immunosorbent assay（ELISA）. The predictive value for PD in elderly patients undergoing abdominal operation was analyzed. Results Plasma GFAP concentrations of case group at T1, T2, T3 and T4 were al significantly higher than that of healthy controls（P〈0.01）. A multivariate logistic regression showed that plasma GFAP levels at T1（OR=1.361, 95%CI=1.125-2.109, P〈0.01） and age of patients （OR=1.743, 95%CI=1.242-3.352, P〈0.01） were independent predictors for PD in el-derly patients undergoing abdominal operation. A receiver operating characteristic curve（ROC） analysis showed that the area un-der curve（AUC） of plasma GFAP levels at T1 for prediction of PD was 0.872（95%CI=0.820-0.914, P〈0.01）, and taking 19.9 pg/ml as cut- off level the sensitivity and specificity of plasma GFAP level for predicting PD was 75.0% and 80.2%, respectively. There were no significant differences in AUC of plasma GFAP concentration between T1 and T2 or T1 and T3 （both P〉0.05）;however, AUC at T1 was larger than that at T4（P〈0.05）. Conclusion Plasma GFAP levels are elevated in elderly patients with PD undergo-ing abdominal operation and of predictive value in early identification of PD occurrence.