老年髋关节置换术患者血清IL-6、TNF-α水平与术后慢性疼痛的关系研究

Relationship of serum levels of IL-6 and TNF-α with postoperative chronic pain in elderly patients undergoing hip replacement

摘要:

目的 探讨老年髋关节置换术患者血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平与术后慢性疼痛的关系。方法 2017年12月—2019年5月在天津医科大学总医院进行髋关节置换术治疗的90例老年患者，根据术后6个月是否存在术后慢性疼痛将其分为术后慢性疼痛组20例，无术后慢性疼痛组70例。比较两组患者的围手术期血清IL-6、TNF-α水平及临床资料差异；采用Logistic回归分析老年髋关节置换术患者术后慢性疼痛发生的危险因素；采用受试者工作特征（ROC）曲线分析围手术期血清IL-6、TNF-α水平对术后慢性疼痛发生的预测价值。结果 两组患者的IL-6、TNF-α水平比较，采用重复测量设计的方差分析，结果 ①不同时间点的IL-6、TNF-α水平有差异（P <0.05）；②两组的IL-6、TNF-α水平有差异（P <0.05），两组术后24 h、术后3 d、术后7 d的IL-6、TNF-α水平均较术前升高，术后慢性疼痛组术后24 h、术后3 d、术后7 d的IL-6、TNF-α水平均高于无术后慢性疼痛组；③两组的IL-6、TNF-α水平变化趋势有差异（P <0.05）。两组患者术中出血量、术中输血量、手术时间、手术类型、术后24 h NRS评分、饮酒比例比较，差异有统计学意义（P <0.05）。Logistic回归分析结果显示：术中出血量［O^R=1.945（95% CI：1.427，2.234）］、手术时间［O^R=1.655（95% CI：1.307，1.938）］、术后24 h NRS评分［O^R=2.453（95% CI：1.847，3.271）］、术后3 d IL-6水平［O^R=2.210（95% CI：1.625，2.758）］及术后3 d TNF-α水平［O^R=2.063（95% CI：1.505，2.460）］是老年髋关节置换术患者术后慢性疼痛发生的危险因素（P <0.05）。ROC曲线结果显示，术后3 d IL-6预测老年髋关节置换术患者术后慢性疼痛发生的截断值为13.75 pg/mL，AUC为0.830（95% CI：0.741，0.919），敏感性、特异性分别为80.0%（95% CI：0.687，0.886）、70.0%（95% CI：0.457，0.881）；术后3 d TNF-α预测老年髋关节置换术患者术后慢性疼痛发生的截断值为13.30 pg/mL，AUC为0.797（95% CI：0.689，0.905），敏感性、特异性分别为72.9%（95% CI：0.699，0.828）、65.0%（95% CI：0.408，0.846）。结论 老年髋关节置换术患者术后3 d IL-6、TNF-α水平是术后慢性疼痛发生的独立危险因素，且具有一定早期预测价值。

Abstract:

Objective To investigate the relationship of serum levels of IL-6 and TNF-a with chronic postoperative pain (CPSP) in elderly patients underwent hip replacement.Methods Ninty cases of elderly hip replacement patients in our hospital during December 2017 to May 2019 were divided into CPSP group (n = 20) and non-cpsp group (n = 70) according to CPSP 6 months after surgery. Perioperative serum levels of IL-6, TNF-α and clinical data between two groups were compared. Risk factors of CPSP in elderly hip replacement patients were analyzed by logistics regression. Predictive values of perioperative serum levels of IL-6 and TNF-α on CPSP were analyzed by ROC curve.Results ANOVA assay was used to compare the level of IL-6 and TNF-α in two group. The results showed: (1) There were differences of IL-6 and TNF-α at different time points (P < 0.05); (2) The levels of IL-6 and TNF-α had significant differences in the two groups. The levels of IL-6 and TNF-α increased 24 hours, 3 days and 7 days after operation than before surgery (P < 0.05). The levels of IL-6 and TNF in postoperative chronic pain group were higher at these time points than those in the group without postoperative chronic pain; (3) There was a difference in the level change trend of IL-6 and TNF-α in both groups (P < 0.05). The amount of intraoperative blood loss, intraoperative blood transfusion, operation time, operation type, NRS score at 24 hours after operation, and drinking proportion had significant differences between two groups (P < 0.05). Logistic regression analysis showed that: intraoperative blood loss [O^R = 1.945 (95% CI: 1.427, 2.234) ], operation time [O^R = 1.655 (95% CI: 1.307, 1.938) ], NRS score at 24 hours after operation [O^R = 2.453 (95% CI: 1.847, 3.271) ], IL-6 level at 3 days after operation [O^R = 2.210 (95% CI: 1.625, 2.758)] and TNF-α at 3 days after operation [O^R = 2.063 (95% CI: 1.505, 2.460) ] were risk factors for postoperative chronic pain in elderly patients undergoing hip replacement (P <0.05). ROC curve showed that the cut-off value of IL-6 for predicting postoperative chronic pain in elderly patients undergoing hip arthroplasty was 13.75 pg/mL; AUC was 0.830 (95% CI: 0.741, 0.919); sensitivity and specificity were 80.0% (95% CI: 0.687, 0.886) and 70.0% (95% CI: 0.457, 0.881); The cutoff of TNF-α at 3 days after operation value for predicting the incidence of chronic pain in elderly patients undergoing hip replacement was 13.30 pg/mL; AUC was 0.797 (95% CI: 0.689, 0.905); sensitivity and specificity were 72.9% (95% CI: 0.699, 0.828) and 65.0% (95% CI: 0.408, 0.846).Conclusion Abnormal increasing of IL-6 and TNF-α levels at 3 days after surgery,which has certain early prediction value, are independent risk factors of the occurrence of CPSP for elderly hip replacement patients.