术前轻度认知功能障碍对早期术后认知功能障碍的预测价值

[摘要]目的：评估非神经/非心脏手术术前存在MCI的患者术后早期POCD的发病率，明确MCI对术后发生早期POCD的预测价值。方法：回顾性分析2018年9月至2021年6月上海市同济医院行非心脏/非神经外科共106例手术患者的病例资料，所有入组患者于手术前至少一天和术后第七天进行神经心理学评估,排除4例MMSE＜23分。将研究对象随机分为建模组（87例）和验证组（15例）。建模组人群根据MCI诊断标准将患者分为MCI组和非MCI组，比较其术后早期POCD的发病率。同时对POCD组和非POCD组进行比较，分析各因素与发生早期POCD之间的关系，找出具有统计学意义的因素（P<0.05），并运用Logistic回归分析确定发生早期POCD的危险因素，构建发生早期POCD的预测模型。验证组人群用来对预测模型进行外部验证，进而评估该预测模型的诊断价值。结果：建模人群中MCI患者28例（32.2%），发生早期POCD的患者6例（21.4%），非MCI患者59例（67.8%），发生早期POCD的患者16例（27.1%），两组患者发生早期POCD的风险无统计学意义（P=0.568，P>0.05）。在对各种相关因素（P<0.05）与早期POCD发生之间的关系进行Logistic回归分析后发现，数字符号替代测试（符号）评分结果是发生早期POCD的独立危险因素(P=0.03)。对构建的预测模型进行外部验证，建模组AUC值为0.883（95%CI0.807-0.959），验证组AUC值为0.840（98%CI0.583-1.000），无论是建模组还是验证组，其校准曲线均提示该预测模型具有较好的稳定性。结论：术前预先存在MCI并不影响术后早期POCD的发生。

Predictive value of preoperative mild cognitive impairment for early postoperative cognitive dysfunction

Objective:To evaluate the incidence rate of POCD in patients with MCI before operation and to evaluate the predictive value of MCI for early POCD after operation. Methods:The case data of 106 patients undergoing non cardiac / non neurosurgery in Shanghai Tongji Hospital from September 2018 to June 2021 were retrospectively analysed. All the enrolled patients underwent neuropsychological evaluation at least one day before the operation and the seventh day after the operation. Four patients with MMSE < 23 points were excluded. The subjects were randomly divided into experimental group (87 cases) and control group (15 cases). The patients in the experimental group were divided into MCI group and non-MCI group according to the MCI diagnostic criteria, and the incidence rate of early postoperative POCD was compared. At the same time, the POCD group and the non-POCD group were compared, the relationship between various factors and early POCD was analysed, the statistically significant factors were found (P < 0.05), the risk factors of early POCD were determined by logistic regression analysis, and the prediction model of early POCD was constructed. The control group is used to externally corroborate the prediction model, and then evaluate the diagnostic value of the prediction mode.Results:There were 28 patients with MCI (32.2%), 6 patients with early POCD (21.4%), 59 patients with non-MCI (67.8%), and 16 patients with early POCD (27.1%). The risk of early POCD in the two groups was not statistically significant (P = 0.568, P > 0.05). After logistic regression analysis of the relationship between various related factors (P < 0.05) and the occurrence of early POCD, it was found that the score of Digital symbol substitution test (DSST) was an independent risk factor for the occurrence of early POCD (P = 0.03). External validation was conducted on the constructed prediction model. The AUC value of the experimental group was 0.883 (95% ci0.807-0.959) and that of the control group was 0.840 (98% ci0.583-1.000). The calibration curve of both the experimental group and the control group showed that the prediction model had good stability. Conclusion:The pre-existing MCI before operation does not affect the occurrence of POCD in the early stage after operation.