Tabata Tomohisa, Yagi Mitsuru, Suzuki Satoshi, Takahashi Yohei, Ozaki Masahiro, Tsuji Osahiko, Nagoshi Narihito, Matsumoto Morio, Nakamura Masaya, Watanabe Kota
Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Otawara 324-8501, Japan.
J Clin Med. 2024 Apr 16;13(8):2294. doi: 10.3390/jcm13082294.
: An important aspect of the pathophysiology of frailty seems to be the dysregulation of inflammatory pathways and the coagulation system. However, an objective assessment of the impact of frailty on the recovery from surgery is not fully studied. This study sought to assess how frailty affects the recovery of adult spinal deformity (ASD) surgery using blood biomarkers. : 153 consecutive ASD patients (age 64 ± 10 yr, 93% female) who had corrective spine surgery in a single institution and reached 2y f/u were included. The subjects were stratified by frailty using the modified frailty index-11 (robust [R] group or prefrail and frail [F] group). Results of commonly employed laboratory tests at baseline, 1, 3, 7, and 14 post-operative days (POD) were compared. Further comparison was performed in propensity-score matched-39 paired patients between the groups by age, curve type, and baseline alignment. A correlation between HRQOLs, major complications, and biomarkers was performed. : Among the propensity-score matched groups, CRP was significantly elevated in the F group at POD1,3(POD1; 5.3 ± 3.1 vs. 7.9 ± 4.7 = 0.02, POD3; 6.6 ± 4.6 vs. 8.9 ± 5.2 = 0.02). Transaminase was also elevated in the F group at POD3(ASD: 36 ± 15 vs. 51 ± 58 U/L, = 0.03, ALT: 32 ± 16 vs. 47 ± 55 U/L, = 0.04). Interestingly, moderate correlation was observed between transaminase at POD1 and 2 y SRS22 (AST; function r = -0.37, mental health r = -0.39, satisfaction -0.28, total r = -0.40, ALT; function r = -0.37, satisfaction -0.34, total r = -0.39). : Frailty affected the serum CRP and transaminase differently following ASD surgery. Transaminase at early POD was correlated with 2 y HRQOLs. These findings support the hypothesis that there is a specific physiological basis to the frailty that is characterized in part by increased inflammation and that these physiological differences persist.
衰弱病理生理学的一个重要方面似乎是炎症途径和凝血系统的失调。然而，关于衰弱对手术恢复影响的客观评估尚未得到充分研究。本研究旨在使用血液生物标志物评估衰弱如何影响成人脊柱畸形（ASD）手术的恢复情况。纳入了在单一机构接受脊柱矫正手术且随访达2年的153例连续ASD患者（年龄64±10岁，93%为女性）。使用改良衰弱指数-11对受试者进行衰弱分层（强壮[R]组或衰弱前期和衰弱[F]组）。比较了基线、术后1、3、7和14天（POD）常用实验室检查的结果。通过年龄、曲线类型和基线对线情况，在倾向评分匹配的39对配对患者组之间进行了进一步比较。对健康相关生活质量、主要并发症和生物标志物之间进行了相关性分析。在倾向评分匹配组中，F组在POD1、3时CRP显著升高（POD1：5.3±3.1 vs. 7.9±4.7，P = 0.02；POD3：6.6±4.6 vs. 8.9±5.2，P = 0.02）。F组在POD3时转氨酶也升高（ASD：36±15 vs. 51±58 U/L，P = 0.03；ALT：32±16 vs. 47±55 U/L，P = 0.04）。有趣的是，观察到POD1时的转氨酶与2年SRS22之间存在中度相关性（AST；功能r = -0.37，心理健康r = -0.39，满意度 -0.28，总r = -0.40；ALT；功能r = -0.37，满意度 -0.34，总r = -0.39）。衰弱对ASD手术后血清CRP和转氨酶的影响不同。早期POD时的转氨酶与2年健康相关生活质量相关。这些发现支持了这样一种假设，即衰弱存在特定的生理基础，部分特征为炎症增加，且这些生理差异持续存在。
