Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2018 Jan;25(1):231-238. doi: 10.1245/s10434-017-6118-6. Epub 2017 Oct 20.
This study aimed to evaluate the influence that serum levels of vitamin B12, folate, and homocysteine have on the development of short-term postoperative cognitive decline in the elderly surgical oncology patient.
This study was part of a prospective cohort study focused on postoperative cognitive outcomes for patients 65 years of age or older undergoing surgery for a solid malignancy. Postoperative cognitive decline was defined as the change in the combined results of the Ruff Figural Fluency Test and the Trail-Making Test Parts A and B. Patients with the highest change in scores 2 weeks postoperatively compared with baseline were considered to be patients with cognitive decline. Patients with the lowest change were considered to be patients without cognitive decline. To analyze the effect of vitamin levels on the changes in postoperative cognitive scores, uni- and multivariate logistic regression analysis were performed.
The study enrolled 61 patients with and 59 patients without postoperative cognitive decline. Hyperhomocysteinemia was present in 14.2% of the patients. Patients with postoperative cognitive decline more often had hyperhomocysteinemia (27.9 vs 10.2%). Hyperhomocysteinemia was associated with a higher chance for the development of postoperative cognitive decline (odds ratio, 11.9; 95% confidence interval, 2.4-59.4). Preoperative vitamin B12 or folate deficiency were not associated with the development of postoperative cognitive decline.
Preoperative hyperhomocysteinemia is associated with the development of postoperative cognitive decline. The presence of preoperative hyperhomocysteinemia could be an indicator for an increased risk of postoperative cognitive decline developing in the elderly.
本研究旨在评估血清维生素 B12、叶酸和同型半胱氨酸水平对老年外科肿瘤患者短期术后认知功能下降的影响。
本研究是一项前瞻性队列研究的一部分，该研究侧重于 65 岁或以上接受实体恶性肿瘤手术的患者的术后认知结果。术后认知功能下降定义为简易精神状态检查、连线测试 A 和 B 的联合结果的变化。与基线相比，术后 2 周评分变化最大的患者被认为是认知功能下降的患者。评分变化最小的患者被认为是认知功能未下降的患者。为了分析维生素水平对术后认知评分变化的影响，进行了单变量和多变量逻辑回归分析。
该研究纳入了 61 例术后认知功能下降患者和 59 例术后认知功能未下降患者。高同型半胱氨酸血症患者占 14.2%。术后认知功能下降患者更常出现高同型半胱氨酸血症（27.9%比 10.2%）。高同型半胱氨酸血症与术后认知功能下降的发生几率增加相关（优势比，11.9；95%置信区间，2.4-59.4）。术前维生素 B12 或叶酸缺乏与术后认知功能下降的发生无关。
术前高同型半胱氨酸血症与术后认知功能下降的发生相关。术前高同型半胱氨酸血症的存在可能是老年患者术后认知功能下降风险增加的一个指标。
