脑氧饱和度及血清pNF-H、BDNF对老年人结直肠癌术后谵妄的预测价值

doi:10.3969/j.issn.1003-9198.2026.05.007

摘要/Abstract

摘要： 目的探究脑氧饱和度(rSO₂)联合血清磷酸化神经丝重链(pNF-H)、脑源性神经营养因子(BDNF)对老年人结直肠癌(CRC)术后谵妄(POD)的预测价值。方法选择2022年2月至2025年2月在临沂市中心医院接受根治性手术的225例老年CRC患者为研究对象,根据是否发生POD将其分为POD组与非POD组。术中持续监测不同时间点rSO₂水平并计算rSO₂变化率;采用酶联免疫吸附试验检测患者术前血清pNF-H、BDNF水平。采用logistic回归分析POD的影响因素;采用ROC曲线评估各指标单独及联合对POD的预测价值。结果 POD组手术时间、血清前列腺素E2(PGE2)、S100钙结合蛋白β(S100β)、pNF-H水平均高于非POD组,血清BDNF水平低于非POD组(P＜0.05)。POD组rSO₂变化率高于非POD组(P＜0.05)。多因素logistic回归分析显示,手术时间、PGE2、S100β蛋白、rSO₂变化率、pNF-H、BDNF均是CRC术后发生POD的影响因素(P＜0.05)。rSO₂变化率联合血清pNF-H、BDNF预测POD的AUC为0.907,显著大于rSO₂变化率(AUC=0.805,Z=2.892,P=0.003)、pNF-H (AUC=0.767,Z=4.141,P＜0.001)及BDNF(AUC=0.784,Z=2.834,P=0.005)的单独预测价值。结论血清pNF-H、BDNF联合术中rSO₂变化率对CRC患者POD的预测价值较高,有助于实现高危POD患者的早期识别与干预。

关键词: 结直肠癌, 脑氧饱和度, 磷酸化神经丝重链, 脑源性神经营养因子, 术后谵妄

Abstract: Objective To investigate the predictive value of combining intraoperative cerebral oxygen saturation (rSO₂) with preoperative serum levels of phosphorylated neurofilament heavy chain (pNF-H) and brain-derived neurotrophic factor (BDNF) for postoperative delirium (POD) in the elderly patients with colorectal cancer (CRC). Methods From February 2022 to February 2025, A total of 225 elderly CRC patients undergoing radical surgery at Linyi Central Hospital were enrolled. They were divided into POD and non-POD groups based on the occurrence of POD. Intraoperative rSO₂ was continuously monitored at different time points, and the rSO₂ fluctuation rate was calculated. Preoperative serum levels of pNF-H and BDNF were measured using enzyme-linked immunosorbent assay. Logistic regression analysis was performed to identify risk factors influencing POD. The predictive value of individual and combined indicators for POD was evaluated using receiver operating characteristic (ROC) curves. Results The POD group exhibited significantly higher levels of surgical duration, serum levels of prostaglandin E2 (PGE2), S100 calcium-binding protein β (S100β), and pNF-H compared to the non-POD group, while serum BDNF levels were lower (P<0.05). The rSO₂ fluctuation rate was significantly higher in the POD group than that in the non-POD group(P<0.05). Multivariate logistic regression analysis indicated that surgical duration, PGE2, S100β protein, rSO₂ fluctuation rate, pNF-H, and BDNF were independent factors influencing POD (P<0.05). The area under the ROC curve (AUC) for predicting POD using the combination of rSO₂ fluctuation rate, serum pNF-H, and BDNF was 0.907, significantly higher than the AUC of rSO₂ fluctuation rate alone (AUC=0.805, Z=2.892, P=0.003), pNF-H alone (AUC=0.767, Z=4.141, P<0.001), and BDNF alone (AUC=0.784, Z=2.834, P=0.005). Conclusions The combination of serum pNF-H and BDNF levels with intraoperative rSO₂ fluctuation rate demonstrates high predictive value for the occurrence of POD in elderly CRC patients, which may aid in the early identification and intervention for high-risk individuals.

Key words: colorectal cancer, cerebral oxygen saturation, phosphorylated neurofilament heavy chain, brain-derived neurotrophic factor, postoperative delirium

中图分类号:

R 735.3

马玉峰, 朱喆, 黄志光, 邱彦明. 脑氧饱和度及血清pNF-H、BDNF对老年人结直肠癌术后谵妄的预测价值[J]. 实用老年医学, 2026, 40(5): 469-473.

MA Yufeng, ZHU Zhe, HUANG Zhiguang, QIU Yanming. Predictive value of cerebral oxygen saturation and serum levels of pNF-H and BDNF for postoperative delirium in elderly patients with colorectal cancer[J]. Practical Geriatrics, 2026, 40(5): 469-473.

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