外周血围手术期血小板计数与大型骨科手术后 PND 的早期阶段相关：一项前瞻性观察研究。
Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study.
机构信息
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
出版信息
BMC Geriatr. 2022 Mar 14;22(1):200. doi: 10.1186/s12877-022-02899-7.
BACKGROUND
Perioperative neurocognitive disorders (PND) are common complications of major surgery among elderly patients, remarkably decreasing patients' life quality. Platelet count has been proved to be an essential factor in inflammation. However, as far as we know, the relationship between platelet count and PND is not clear yet in the orthopedic area. PND could be a long-term disease, which sometimes lasts for several years, and it is meaningful to find a biomarker of PND at the early stage. Thus, we designed this study to find out the association between perioperative platelet count and occurrence of PND, and determine whether preoperative platelet count could be a biomarker of the early stage of PND.
METHODS
A prospective observational study was performed on the patients who would take total knee arthroplasty or total hip arthroplasty. Their peripheral platelets were counted by blood routine examination 1 day before and 3 days after the surgery. And we assessed their neurocognitive functions 1 day before and 3 days after the surgery. These data were recorded and analyzed to find out the relationship between platelet count and the occurrence of PND.
RESULTS
Eventually, 70 patients finished the whole process, and 14 of them developed PND. The median preoperative platelet count in the PND group was significantly higher than that in the non-PND group (239 vs 168 × 10^9/L, p = 0.009). Preoperative platelet count was an independent risk factor for PND (odds ratio = 1.014, 95% confidence interval [CI] 1.000-1.027, P = 0.043) in the logistic multivariable regression, while the area under the curve of the receiver operating characteristic curve of the prediction model was 0.796 (95% CI 0.676-0.916).
CONCLUSIONS
The higher preoperative and postoperative level of platelet count in the peripheral blood were associated with the early stage of PND, and preoperative platelet count could be a potential predictor of the early stage of PND in patients undergoing major orthopedic surgeries.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR2000033001 , registration date: 17 May 2020.
背景
围手术期神经认知障碍（PND）是老年患者大手术后常见的并发症，显著降低了患者的生活质量。血小板计数已被证明是炎症的一个重要因素。然而，据我们所知，血小板计数与 PND 之间的关系在骨科领域还不清楚。PND 可能是一种长期疾病，有时可持续数年，因此，在早期发现 PND 的生物标志物具有重要意义。因此，我们设计了这项研究，以探讨围手术期血小板计数与 PND 发生之间的关系，并确定术前血小板计数是否可以作为 PND 早期阶段的生物标志物。
方法
对拟行全膝关节置换术或全髋关节置换术的患者进行前瞻性观察性研究。手术前 1 天和手术后 3 天通过血常规检查计数外周血小板。并在手术前 1 天和手术后 3 天评估他们的神经认知功能。记录和分析这些数据，以找出血小板计数与 PND 发生之间的关系。
结果
最终有 70 例患者完成了整个过程，其中 14 例发生了 PND。PND 组术前血小板计数中位数明显高于非 PND 组（239 与 168×10^9/L，p=0.009）。术前血小板计数是 PND 的独立危险因素（比值比=1.014，95%置信区间[CI] 1.000-1.027，p=0.043）在逻辑多元回归中，而预测模型的受试者工作特征曲线下面积为 0.796（95%CI 0.676-0.916）。
结论
外周血中较高的术前和术后血小板计数水平与 PND 的早期阶段有关，术前血小板计数可能是接受大型骨科手术患者 PND 早期的潜在预测指标。
试验注册
中国临床试验注册中心：ChiCTR2000033001，注册日期：2020 年 5 月 17 日。
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