术前较低的血尿酸水平可能是老年髋部骨折手术患者术后精神障碍的危险因素：一项匹配的病例对照研究

术前较低的血尿酸水平可能是老年髋部骨折手术患者术后精神障碍的危险因素：一项匹配的病例对照研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：张中伟  编辑：张中伟  审核：曹莹

罂 粟 摘 要 

背景：术后精神障碍(POD)是髋部骨折术后常见的并发症，与患者的各种近期和远期预后有关。POD的发病机制可能与氧化应激过程有关。已有研究表明尿酸可通过其抗氧化特性在各种神经退行性疾病中提供神经保护作用。然而，较低的术前血尿酸水平是否与髋部骨折术后POD的发生有关目前仍不清楚。因此，这项研究评估了住院期间患者POD的发生与术前尿酸水平的相关性。

方法：这是一项匹配的回顾性病例对照研究，本研究纳入96名接受髋部骨折手术的老年患者(≥65岁)。使用《精神障碍诊断和统计手册》第五版对POD进行诊断。在年龄、性别和麻醉类型相同的基础上，诊断为POD的患者(病例组)与没有POD的患者(对照组)进行1：1匹配。采用多因素分析的方法分析术前尿酸与POD的关系。

结果：POD组和非POD组各48例。在单因素分析中，POD患者比非POD患者更有可能出现较低的术前血尿酸值、较高的中性粒细胞/淋巴细胞比率和脑血管疾病。多因素条件Logistic回归分析显示，术前血尿酸水平较低(调整后优势比0.028；可信区间0.001~0.844；p=0.040)、中性粒细胞/淋巴细胞比率较高(调整后优势比1.314；95%可信区间1.053~1.638；p=0.015)、手术时间延长(调整后优势比1.034；95%可信区间1.004~1.065；p=0.024)与POD发生的风险增加相关。

结论：调整可能的混杂因素后，术前较低的血尿酸水平可能是POD的独立危险因素。然而，需要大量的前瞻性研究来证实这一发现。

原始文献来源：Lin Xu, Wenyuan Lyu, Penghui Wei.Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study.[J]. BMC Anesthesiol(2022) 22:282

英文原文 

Lower preoperative serum uric acid level

may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

Abstract

Background:Postoperative delirium (POD) is a common complication after hip fracture surgery that is associated with various short- and long-term outcomes. The mechanism of POD may be associated with the oxidative stress process. Uric acid has been shown to provide a neuroprotective effect in various neurodegenerative diseases through its antioxidant properties. However, it is unclear whether lower preoperative serum uric acid levels are associated with the development of POD after hip fracture surgery. Therefore, this study assessed the association of lower preoperative uric acid levels in patients with POD during hospitalization.

Methods:This is a matched retrospective case-control study that included 96 older patients (≥65 y) who underwent hip fracture surgery. POD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients diagnosed with POD (cases) were matched 1:1 with patients without POD (controls) on the basis of age, sex, and anesthesia type. The relationship between preoperative uric acid and POD was analyzed by multivariable analysis.

Results: The POD and non-POD groups each had 48 patients. In the univariate analysis, lower log preoperative serum uric acid value, higher neutrophil-to-lymphocyte ratio, and cerebrovascular disease were more likely in patients with POD than in those with no POD. Multivariable conditional logistic regression analysis showed that lower log preoperative serum uric acid (adjusted odds ratio [aOR], 0.028; confidence interval [CI], 0.001–0.844; p = 0.040), higher neutro-phil-to-lymphocyte ratio (aOR, 1.314; 95% CI, 1.053–1.638; p = 0.015), and increased surgery duration (aOR, 1.034; 95%

CI, 1.004–1.065; p = 0.024) were associated with increased risk of POD.

Conclusions:Lower preoperative serum uric acid levels may be an independent risk factor for POD after adjustment for possible confounding factors. However, large prospective studies are needed to confirm this finding.

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