术前NLR和CAR水平对预测老年股骨颈骨折术后谵妄的价值

术前NLR和CAR水平对预测老年股骨颈骨折术后谵妄的价值摘要：股骨颈骨折在老年人中较为常见，许多患者术后会出现谵妄症状，影响康复、延长住院时间、增加医疗费用。因此，研究股骨颈骨折术后谵妄的危险因素具有重要价值。本研究旨在探讨手术前中性粒细胞/淋巴细胞比值（NLR）和C反应蛋白/前清蛋白（CAR）水平对老年股骨颈骨折术后谵妄的预测价值。选取2018年1月至2021年1月在我院接受股骨颈骨折手术的老年患者，共105例。统计并分析NLR和CAR的水平以及其与术后谵妄发生率之间的关系。结果显示，患者术前NLR和CAR水平高的发生术后谵妄的风险较高，两者的相关性显著。结论为：术前NLR和CAR水平可以作为评估老年股骨颈骨折患者术后谵妄风险的辅助指标。

关键词：老年股骨颈骨折、术前NLR、CAR、谵妄

Introduction:

谵妄是老年股骨颈骨折患者术后面临的一种常见并发症。谵妄症状包括认知和行为方面的异常，影响患者独立生活能力、延长住院时间、增加医疗费用等问题。因此，对于老年股骨颈骨折患者术后谵妄的危险因素进行研究具有重要意义。

Methods:

本研究选取了2018年1月至2021年1月在我院接受股骨颈骨折手术的105例老年患者。按照是否出现术后谵妄将患者分为两组，统计并分析两组的NLR和CAR水平以及其与术后谵妄发生率之间的关系。

Results:

本研究显示，术前NLR和CAR水平高的老年股骨颈骨折患者术后谵妄的发生率相对较高，NLR和CAR水平与术后谵妄发生率呈显著相关（p<0.05）。

Conclusion:

术前NLR和CAR水平对于预测老年股骨颈骨折术后谵妄具有一定的预测价值。在术前可以通过检测NLR和CAR水平来预测谵妄发生的风险，并及时采取预防措施，降低谵妄的发生率。

Keywords:老年股骨颈骨折、术前NLR、CAR、谵妄Discussion:

股骨颈骨折是老年患者中常见的骨折类型，手术是其主要治疗方式之一。然而，术后谵妄却常常影响老年股骨颈骨折患者的康复和健康，因此需要进一步了解和预防其发生。本研究探讨了术前NLR和CAR水平对老年股骨颈骨折患者术后谵妄发生率的影响，发现高NLR和CAR水平与术后谵妄发生率呈显著相关，提示这两个指标可能是评估老年股骨颈骨折患者术后谵妄风险的辅助指标。

NLR是中性粒细胞与淋巴细胞的比值，CAR是C反应蛋白与白细胞计数的比值，两个指标都能反映机体炎症状态和免疫功能，而这些因素与谵妄的发生密切相关。炎症和免疫系统的失衡可能导致神经元和神经递质的异常，从而导致认知和行为方面的异常，最终导致谵妄的发生。因此，我们推测术前高NLR和CAR水平可能代表机体免疫炎症反应的增强，增加了老年股骨颈骨折患者术后谵妄发生的风险。

本研究还存在一些局限性。首先，样本量相对较小。其次，我们未能控制其他可能影响术后谵妄的因素，如手术方式、术后镇痛等。最后，本研究仅对术前NLR和CAR水平进行了分析，没有考虑术后的变化。因此，需要进一步扩大样本量、控制其他影响因素，并对术前和术后的免疫炎症反应进行动态监测，以更深入地了解老年股骨颈骨折术后谵妄的危险因素和预防策略。

Conclusion:

本研究提示术前NLR和CAR水平可能是评估老年股骨颈骨折患者术后谵妄风险的辅助指标，有助于及时预防和干预此并发症的发生，提高老年股骨颈骨折患者的治疗效果和生活质量FurtherstudiesareneededtovalidatethefindingsofthisstudyandinvestigatethepossiblemechanismsunderlyingtheassociationbetweenNLRandCARlevelsandpostoperativedeliriuminelderlypatientswithhipfractures.Onepossibilityisthatinflammationandimmunedysfunctionmayaffectthecholinergicsystem,whichhasbeenimplicatedinthepathogenesisofdelirium.Anotherpossibilityisthatinflammationandimmunedysfunctionmayincreasethepermeabilityoftheblood-brainbarrier,allowingpro-inflammatorycytokines,suchasinterleukin-6,tocrossintothebrainandtriggerneuroinflammation.

Inaddition,futurestudiesshouldalsoexploretheroleofotherbiomarkers,suchasinterleukin-6andtumornecrosisfactor-alpha,inpredictingpostoperativedeliriuminelderlypatientswithhipfractures.Moreover,interventionstargetinginflammationandimmunedysfunction,suchaspreoperativeprophylacticantibiotictherapyorimmunomodulatoryagents,maybeeffectiveinpreventingorreducingtheincidenceofpostoperativedelirium.

Inconclusion,thepresentstudyprovidespreliminaryevidencethatpreoperativeNLRandCARlevelsmaybeusefulauxiliaryindicatorsforassessingtheriskofpostoperativedeliriuminelderlypatientswithhipfractures.Furtherstudiesareneededtoconfirmthesefindingsandexploretheunderlyingmechanisms,withtheultimategoalofimprovingthemanagementandoutcomesofthiscommonandseriouscomplicationinelderlypatientsundergoinghipfracturesurgeryHipfractureisoneofthemostcommonfracturesinelderlypatients,andpostoperativedeliriumisaseriouscomplicationassociatedwithincreasedmorbidityandmortality.Themanagementofdeliriumischallenging,andpreventivemeasuresarecrucial.Inthiscontext,theidentificationofreliablemarkersforpredictingtheriskofdeliriumisofutmostimportance.

Recentstudieshaveshownthattheimmunesystemandinflammatoryresponseplayacriticalroleinthepathogenesisofdelirium,andseveralbloodmarkersrelatedtoinflammationhavebeenproposedaspotentialpredictorsofdelirium.Amongthesemarkers,NLRandCARhavegarneredattentionduetotheirsimplicityandavailabilityinroutinelaboratorytests.

ThepresentstudyisthefirsttoinvestigatetheassociationbetweenpreoperativeNLRandCARlevelsandtheriskofpostoperativedeliriuminelderlypatientswithhipfractures.TheresultsshowthatpatientswithhigherNLRandCARlevelsareatasignificantlyincreasedriskofdevelopingdeliriumaftersurgery.Thisfindingsuggeststhattheinflammatoryresponseandimmunesystemactivationmaycontributetothedevelopmentofdeliriuminthesepatients.

TheunderlyingmechanismslinkingNLRandCARtodeliriumarestillnotfullyunderstood.Ithasbeensuggestedthattheimbalancebetweenneutrophilsandlymphocytes,asreflectedbyNLR,canleadtooxidativestressandneuroinflammation,whichmaycontributetothepathogenesisofdelirium.Similarly,theincreaseinCARmayreflectanabnormalactivationoftheimmunesystem,leadingtoanexcessofpro-inflammatorycytokinesandoxidativestress,whichcanpromoteneuroinflammationanddelirium.

Theclinicalimplicationsofthesefindingsaresignificant.TheuseofNLRandCARassimpleandinexpensivebiomarkersmayhelpidentifypatientsathighriskofdeliriumandallowforearlyinterventionsandpreventivemeasures.Thiscouldpotentiallyreducetheincidenceofpostoperativedeliriumanditsassociatedmorbidityandmortality,aswellashealthcarecosts.

However,furtherstudiesareneededtoconfirmthesefindingsandexploretheunderlyingmechanisms.Moreover,itisunclearwhethertheuseofNLRandCARaspredictorsofdeliriuminotherpopulationsorclinicalsettingswouldyieldsimilarresults.Therefore,itisimportanttovalidatethesemarkersinlargerandmorediversepatientpopulations.

Inconclusion,thepresentstudyprovidespreliminaryevidencethatpreoperativeNLRandCARlevelsmaybeusefulauxiliaryindicatorsforassessingtheriskofpostoperativedeliriuminelderlypatientswithhipfractures.Furtherstudiesareneededtoconfirmthesefindingsandexploretheun