Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients
Insulin Resistance Predicts Postoperative Cognitive Dysfunction in Elderly Gastrointestinal Patients
复制标题
DOI：
10.3389/fnagi.2019.00197
复制
发表时间：
2019-08-08
影响因子：
4.8
通讯作者：
Ouyang, Wen
中科院分区：
文献类型：
--
作者：
He, Xi;Long, Ge;Ouyang, Wen
背景：接受手术的老年人有术后认知功能障碍（POCD）的风险。探索一个有效和可靠的早期预测POCD是必不可少的识别高危患者，并作出前瞻性的决定。本研究的目的是研究术前胰岛素抵抗是否是POCD.Methods的一个独立的预测因素：共124例患者年龄在60岁及以上，谁被安排进行胃肠道手术，被纳入一项前瞻性的观察性临床研究。所有参与者在手术前和手术后7天完成了一系列神经心理学测试。POCD被定义为在两个或两个以上的神经心理学测试中至少下降1.5 SD。测量肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）和S-100 β蛋白的血浆浓度。采用胰岛素抵抗稳态模型（HOMA-IR）评价胰岛素抵抗状态。结果：51例患者（41.1%）在术后第7天诊断为POCD，其中11例（41.1%）患者（100例）在术后第7天诊断为POCD。POCD组术前HOMA-IR值明显高于非POCD组。POCD组术后各时间点CRP、TNF-α水平均显著高于对照组（P < 0.05）。术前HOMA-IR值是POCD的独立预测因子（调整后OR 1.88，95%CI，1.18-2.99），即使在调整混杂变量后，当二分时，高于HOMA-IR阈值（HOMA-IR > 2.6）的个体与低于阈值的个体相比，POCD的风险高3倍（OR 3.26; 95%CI，1.07-9.91）。HOMA-IR的ROC曲线下面积为0.804（95%CI，0.725-0.883; P < 0.001）。最佳临界值为0.583，敏感性为84.3%，特异性为74%。HOMA-IR值与术前（R-2 = 0.43，P < 0.01）和术后第1天（R-2 = 0.3861，P < 0.01）TNF-α浓度呈正相关。针对性的胰岛素抵抗防治策略可能是对POCD高危患者的有效干预措施。
Background: Members of the aging population who undergo surgery are at risk of postoperative cognitive dysfunction (POCD). Exploring an effective and reliable early predictor of POCD is essential to the identification of high-risk patients and to making prospective decisions. The purpose of this study was to examine whether preoperative insulin resistance is an independent predictor of POCD.Methods: A total of 124 patients aged 60 years and older and who were scheduled for gastrointestinal surgery were enrolled in a prospective observational clinical study. All participants completed a battery of neuropsychological tests before surgery and 7 days later. POCD was defined as a decline of at least 1.5 SD on two or more of neuropsychological tests. Plasma concentration of the tumor necrosis factor alpha (TNF-alpha), C-reactive protein (CRP), and S-100 beta protein were measured. The status of insulin resistance was assessed by Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). The relationship between HOMA-IR and POCD was assessed by Multivariable logistic regression models and the receiver operating characteristic (ROC) curve.Results: Fifty one patients (41.1%) were diagnosed with POCD at 7 days after surgery. Preoperative HOMA-IR values of the POCD group were significantly higher than the non-POCD group. Furthermore, CRP and TNF-alpha levels of the POCD group were significantly higher at each postoperative time point (P < 0.05). The preoperative HOMA-IR value was an independent predictor of POCD (adjusted OR 1.88, 95% CI, 1.18-2.99) even after adjust for confounding variables, and when dichotomized, individuals above the HOMA-IR threshold (HOMA-IR > 2.6) had a three-times higher risk of POCD (OR 3.26; 95% CI, 1.07-9.91) compared to individuals below the threshold. The areas under the ROC curve of HOMA-IR was 0.804 (95% CI, 0.725-0.883; P < 0.001). The optimal cut-off value was found to be 0.583, with a sensitivity of 84.3% and specificity of 74%. The HOMA-IR value was positively associated with the TNF-alpha concentration at baseline (R-2 = 0.43, P < 0.01) and 1 day after surgery (R-2 = 0.3861, P < 0.01).Conclusion: Preoperative insulin resistance is an effective predictor for the occurrence of POCD. Targeted prevention and treatment strategies of insulin resistance may be effective interventions of patients at risk for POCD.