【摘要】 目的 探讨血清β-淀粉样蛋白1-42(Aβ1-42)、微管相关蛋白（Tau）水平对老年髋关节置换术患者术后谵妄（POD）的预测价值。方法 将2021年1月至2024年5月于南京中医药大学第三临床医学院行髋关节置换术的178例老年患者纳入本研究。术后1～7 d内采用意识模糊评估量表（CAM）评估所有患者是否发生POD，并设立POD组（36例）和未POD组（142例）。比较两组血清Aβ1-42、Tau水平，绘制受试者工作特性曲线（ROC）评价血清Aβ1-42、Tau对老年髋关节置换术患者POD的评估价值，采用多因素logistic回归分析探讨老年髋关节置换术患者POD的影响因素。结果 POD组患者血清Aβ1-42水平低于未POD组、Tau水平明显高于未POD组，差异有统计学意义（P<0.05）。血清Aβ1-42、Tau及两者联合评估老年髋关节置换术患者POD的AUC(95%CI)分别为0.719(0.674～0.764)、0.803(0.758～0.848)、0.922(0.877～0.972)。POD组患者术后苏醒时间≥60 min、ASA分级Ⅲ～Ⅳ级、糖尿病、脑卒中占比均高于未POD组，差异有统计学意义（P<0.05）。多因素分析显示：糖尿病（OR=2.499,95%CI:1.256～4.973），脑卒中（OR=2.672,95%CI:1.354～5.276），血清Aβ1-42<420.12 pg/mL(OR=3.633,95%CI:1.808～7.299)，血清Tau≥230.22 pg/mL(OR=4.591,95%CI:2.129～9.898)是老年髋关节置换术患者POD的影响因素（P<0.05）。结论 血清Aβ1-42水平下降、Tau上升与老年髋关节置换术患者发生POD密切相关，两指标联合检测具有较高的预测价值。更多还原

【Abstract】 Objective To explore the predictive value of serum β-amyloid protein 1-42(Aβ1-42) and microtubule associated protein(Tau) levels for postoperative delirium(POD) in elderly patients undergoing hip replacement surgery. Methods 178 elderly patients who underwent hip replacement surgery at the Third Clinical School of Nanjing University of Traditional Chinese Medicine from January 2021 to May 2024were included in this study. Serum Aβ1-42 and Tau levels were detected in all patients. From 1 to 7 days after operation, POD was assessed by the unconsciousness Assessment Scale(CAM), and POD group(36 cases) and a non-POD group(142 cases) were set up. Serum Aβ1-42 and Tau levels were compared between the two groups, and a receiver operating characteristic curve(ROC) was plotted to evaluate the diagnostic value of serum Aβ1-42 and Tau on POD in elderly patients with hip replacement. The influencing factors of POD in elderly patients with hip replacement were explored by multivariate logistic regression analysis. Results The serum Aβ1-42 level in the POD group was lower than that in the non-POD group, and the serum Tau level was higher than that in the non-POD group, with statistical significance(P<0.05). The POD AUC(95%CI) for serum Aβ1-42, Tau, and their combination were 0.719(0.674～0.764), 0.803(0.758～0.848), and 0.922(0.877～0.972) in elderly hip replacement patients, respectively. The postoperative recovery time for patients in the POD group was ≥60 min, with ASA grade Ⅲ～Ⅳ, diabetes, and a higher proportion of stroke compared to the nonPOD group( P<0.05). Multivariate analysis showed that diabetes mellitus( OR=2.499, 95%CI: 1.256～4.973), stroke( OR=2.672, 95%CI: 1.354～5.276), serum Arum Tau β1-42 <420.12 pg/mL( OR=3.633, 95%CI: 1.808～7.299), se≥230.22 pg/mL( OR=4.591, 95%CI: 2.129～9.898) were the influencing factors for POD in elderly patients undergoing hip replacement(P<0.05). Conclusion The decrease in serum Aise in Tau are closely related to the occurrence of POD in elderly patients undergoingβ1-42 levels and the ncrea hip replacement. The combined detection of these two indicators has high predictive value.更多还原