2023 年第 8 期 第 18 卷

血清可溶性肿瘤坏死因子受体1水平与重症患者并发谵妄和谵妄持续时间的相关性研究

Correlation between serum soluble tumor necrosis factor receptor-1 level and concurrent delirium and duration of delirium in critically ill patients

作者：刘海棠唐倩芸周森

英文作者：Liu Haitang Tang Qianyun Zhou Sen

单位：海南医学院第二附属医院重症监护室，海口570311

英文单位：Intensive Care Unit the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：重症监护病房；谵妄；谵妄持续时间；可溶性肿瘤坏死因子受体1

英文关键词：Intensivecareunit;Delirium;Durationofdelirium;Solubletumornecrosisfactorreceptor-1

• 摘要：

• 目的 探讨血清可溶性肿瘤坏死因子受体1（sTNFR1）水平与重症患者并发谵妄和谵妄持续时间的相关性。方法 选择2021年1月至2022年10月海南医学院第二附属医院重症监护病房收治的328例重症患者作为研究对象，依据患者是否发生谵妄分为谵妄组和非谵妄组，并依据谵妄持续时间中位数将并发谵妄患者进一步分为＞4 d组和≤4 d组。收集受试者的临床资料和血清sTNFR1表达水平。应用多因素Logistic回归方法及受试者工作特征曲线分析血清sTNFR1水平与重症患者并发谵妄和谵妄持续时间的关系。结果 328例重症患者中，共有122例（37.2%）患者并发谵妄。并发谵妄患者的谵妄持续时间为4（3，6）d。多因素Logistic回归分析结果显示，血清sTNFR1水平升高是重症患者并发谵妄和谵妄持续时间＞4 d的独立危险因素（比值比=1.425，95%置信区间：1.271～1.598，P＜0.001；比值比=1.473,95%置信区间：1.227～1.768，P＜0.001）。血清sTNFR1水平预测谵妄的曲线下面积为0.838，截断值为4.36 μg/L，敏感度为83.61%，特异度为69.42%；预测谵妄持续时间＞4 d的曲线下面积为0.793，截断值为6.80 μg/L，敏感度为79.59%，特异度为69.86%。结论 血清sTNFR1水平与重症患者并发谵妄和谵妄持续时间关系密切，且对二者具有一定的预测价值。

• Objective To explore the correlation between serum soluble tumor necrosis factor receptor-1 (sTNFR1) level and concurrent delirium and duration of delirium in critically ill patients. Methods  From January 2021 to October 2022, 328 critically ill patients admitted to the Intensive Care Unit, the Second Affiliated Hospital of Hainan Medical University were selected as the research subjects. According to whether delirium occurred, patients were divided into the delirium group and the non-delirium group, and the patients with concurrent delirium were further divided into ＞4 d group and ≤4 d group according to the median of duration of delirium. The clinical data and the expression levels of sTNFR1 of the subjects were collected. Multivariate Logistic regression method and receiver operating characteristic curve were used to analyze the relationship between serum sTNFR1 level and concurrent delirium and duration of delirium in critically ill patients. Results Of the 328 severe patients, 122 patients (37.2%) were complicated with delirium, and the duration of delirium in patients with delirium was 4(3,6)d. Multivariate Logistic regression analysis showed that elevated serum sTNFR1 level was a risk factor for concurrent delirium and duration of delirium >4 d in critically ill patients (odds ratio=1.425, 95% confidence interval: 1.271-1.598, P＜0.001; odds ratio=1.473, 95% confidence interval: 1.227-1.768, P＜0.001). The area under the curve of serum sTNFR1 level predicting delirium was 0.838, the cutoff value was 4.36 μg/L, sensitivity was 83.61%, and specificity was 69.42%. The area under the curve for predicting duration of delirium ＞4 d was 0.793, the cutoff value was 6.80 μg/L, sensitivity was 79.59%, and specificity was 69.86%. Conclusions    erum sTNFR1 level is closely related to concurrent delirium and duration of delirium in critically ill patients, and it has a certain predictive value for both.