血清NSE、LP-PLA2联合CAR对老年股骨粗隆间骨折患者PFNA内固定术后谵妄的预测价值

摘要 目的：探讨血清神经元特异性烯醇化酶（NSE）、脂蛋白相关磷脂酶A2（LP-PLA2）联合C-反应蛋白与白蛋白比值（CAR）对老年股骨粗隆间骨折患者闭合复位防旋髓内钉（PFNA）内固定术后谵妄的预测价值。方法：选择2020年4月至2023年2月北京中医药大学第三附属医院收治的209例老年股骨粗隆间骨折患者。所有患者均行PFNA内固定术治疗,术前检测血清NSE、LP-PLA2、CAR,术后根据是否发生谵妄分为谵妄组和非谵妄组。多因素Logistic回归分析术后谵妄的因素。受试者工作特征（ROC）曲线分析NSE、LP-PLA2、CAR预测术后谵妄的价值。结果：术后43例发生谵妄,发生率为20.57%。谵妄组血清NSE、LP-PLA2、CAR高于非谵妄组（P＜0.05）。多因素Logistic回归分析显示年龄偏大、手术时间过长、高NSE、高LP-PLA2、高CAR是老年股骨粗隆间骨折患者术后谵妄的危险因素（P＜0.05）。NSE、LP-PLA2、CAR预测老年股骨粗隆间骨折患者术后谵妄的曲线下面积（AUC）为0.784、0.808、0.820,联合预测的AUC 为0.907,高于单独预测。结论：老年股骨粗隆间骨折PENA术后谵妄患者血清NSE、LP-PLA2、CAR增高,高水平NSE、LP-PLA2、CAR是术后谵妄的主要危险因素。联合NSE、LP-PLA2、CAR对术后谵妄风险有较高预测价值。

Predictive Value of Serum NSE, LP-PLA2 Combined with CAR on Postoperative Delirium in Elderly Patients with Intertrochanteric Fracture of Femur after PFNA Internal Fixation

ABSTRACT Objective: To investigate the predictive value of serum neuron specific enolase (NSE), lipoprotein-associated phospholipase A2 (LP-PLA2) combined with C-reactive protein to albumin ratio(CAR) on postoperative delirium in elderly patients with intertrochanteric fracture of femur after proximal femoral nail antirotation(PFNA) internal fixation. Methods: 209 elderly patients with intertrochanteric fracture of femur who were admitted to The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine from April 2020 to February 2023 were selected. All patients were treated with PFNA internal fixation, serum NSE, LP-PLA2 and CAR were detected before operation, patients were divided into delirium group and non-delirium group according to whether delirium occurred after operation. The factors affecting postoperative delirium were analyzed by multivariate Logistic regression analysis. The value of NSE, LP-PLA2 and CAR in predicting postoperative delirium were analyzed by receiver operating characteristic (ROC) curve. Results: Postoperative delirium occurred in 43 cases, with an incidence of 20.57%. Serum NSE, LP-PLA2 and CAR in delirium group were higher than those in non-delirium group(P<0.05). Multivariate Logistic regression analysis showed that older age, longer operation time, high NSE, high LP-PLA2 and high CAR were risk factors for postoperative delirium in elderly patients with intertrochanteric fracture of femur(P<0.05). The area under the curve(AUC) of NSE, LP-PLA2 and CAR in predicting postoperative delirium in elderly patients with intertrochanteric fracture of femur was 0.784, 0.808 and 0.820 respectively, the AUC of combined prediction was 0.907, which was higher than that of single prediction. Conclusion: The levels of serum NSE, LP-PLA2 and CAR are increase in postoperative delirium in elderly patients with intertrochanteric fracture of femur after PFNA internal fixation, high levels of NSE, LP-PLA2 and CAR are the main risk factors for postoperative delirium. The combination of NSE, LP-PLA2 and CAR has a high predictive value for the risk of postoperative delirium.