Wu Xiao-Min, Xu Wei-Cai, Yu Yong-Jian, Han Liang, Zhang Jun, Yang Li-Jiao
Department of Anesthesiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310014, Zhejiang Province, China.
Clin Chim Acta. 2017 Mar;466:93-97. doi: 10.1016/j.cca.2017.01.009. Epub 2017 Jan 14.
Oxidative stress correlates with occurrence and development of postoperative delirium (POD) and cognitive dysfunction (POCD). Thioredoxin (TRX) is a potent anti-oxidant and its circulating concentrations reflect extent of brain injury. We determined the relation of serum TRX concentrations to POD and POCD in elderly patients undergoing hip fracture surgery.
In this prospective, observatory study, TRX concentrations in preoperative and postoperative serum from 192 patients and serum from 192 controls were measured using an enzyme-linked immunosorbent assay. The relationship between TRX concentrations and risk of POD and POCD was assessed using a multivariate analysis.
As compared to the controls, postoperative, but not preoperative serum TRX concentrations were significantly increased in the patients. Furthermore, postoperative TRX concentrations and age were identified as the independent predictors for POD and POCD. Also, area under receiver operating characteristic curve (AUC) of postoperative TRX concentrations was obviously higher than that of age in the prediction of POD and POCD. Additionally, in a combined logistic-regression model, TRX concentrations significantly improved the AUCs of age to predict POD and POCD.
TRX in postoperative serum may be a potential biomarker to predict POD and POCD in elder patients undergoing hip fracture surgery.
氧化应激与术后谵妄（POD）及认知功能障碍（POCD）的发生和发展相关。硫氧还蛋白（TRX）是一种强效抗氧化剂，其循环浓度反映脑损伤程度。我们确定了老年髋部骨折手术患者血清TRX浓度与POD和POCD的关系。
在这项前瞻性观察研究中，采用酶联免疫吸附测定法测量了192例患者术前和术后血清以及192例对照者血清中的TRX浓度。使用多变量分析评估TRX浓度与POD和POCD风险之间的关系。
与对照组相比，患者术后血清TRX浓度显著升高，而术前未升高。此外，术后TRX浓度和年龄被确定为POD和POCD的独立预测因素。而且，在预测POD和POCD方面，术后TRX浓度的受试者工作特征曲线下面积（AUC）明显高于年龄。此外，在一个联合逻辑回归模型中，TRX浓度显著提高了年龄预测POD和POCD的AUC。
术后血清中的TRX可能是预测老年髋部骨折手术患者POD和POCD的潜在生物标志物。
