文章摘要
术前血红蛋白与红细胞分布宽度比值与老年患者胃肠肿瘤术后谵妄及焦虑抑郁状态的相关性
Association between preoperative hemoglobin-to-red blood cell distribution width ratio and postoperative delirium， anxiety， and depression symptoms in elderly patients undergoing gastrointestinal tumor surgery
  
DOI：10.12089/jca.2026.01.002
中文关键词: 老年  胃肠肿瘤手术  血红蛋白与红细胞分布宽度比值  术后谵妄  抑郁状态  焦虑状态
英文关键词: Aged  Gastrointestinal tumor surgery  Hemoglobin-to-red cell distribution width ratio  Postoperative delirium  Depression symptom  Anxiety symptom
基金项目:国家重点研发计划（2018YFC2001901）
作者单位E-mail
张倬宁 100853,北京市,解放军总医院第一医学中心麻醉科  
郝新宇 100853,北京市,解放军总医院第一医学中心麻醉科  
蔡辰 100853,北京市,解放军总医院第一医学中心麻醉科  
郭永馨 100853,北京市,解放军总医院第一医学中心麻醉科  
曹江北 100853,北京市,解放军总医院第一医学中心麻醉科  
刘艳红 100853,北京市,解放军总医院第一医学中心麻醉科  
仝黎 100853,北京市,解放军总医院第一医学中心麻醉科  
米卫东 100853,北京市,解放军总医院第一医学中心麻醉科 wwdd1962@163.com 
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中文摘要:
      
目的：探讨术前血红蛋白与红细胞分布宽度比值（HRR）与老年患者胃肠肿瘤术后谵妄（POD）、焦虑抑郁状态的相关性。
方法：选择2020年4月至2022年4月择期行胃肠肿瘤手术的老年患者，记录患者术前血常规指标血红蛋白（Hb）和红细胞分布宽度（RDW）。主要指标为术后7 d内POD发生情况，采用3分钟谵妄诊断量表（3D-CAM）进行评估。次要指标包括术后7 d内的焦虑、抑郁状态发生情况，分别采用广泛性焦虑障碍量表（GAD-7）以及患者健康问卷（PHQ-9）评估。采用Logistic回归分析HRR与结局的相关性，限制性立方样条（RCS）分析HRR与结局的非线性关联可能性，受试者工作特征（ROC）曲线分析HRR预测结局的效能。
结果：共纳入患者345例，其中60例（17.4%）患者发生POD，75例（21.4%）患者存在术后抑郁状态，91例（26.4%）患者存在术后焦虑状态。对年龄、BMI、术前焦虑抑郁状态、术前Hb、RDW、白细胞、白蛋白、术中出血量以及是否输血进行校正，多因素Logistic回归模型分析显示，HRR与POD（OR=0.62，95%CI 0.51～0.73，P<0.001）、抑郁状态（OR=0.76，95%CI 0.63～0.91，P=0.003）以及焦虑状态（OR=0.77，95%CI 0.66～0.92，P=0.003）均呈显著负相关。RCS分析验证了HRR与POD、抑郁状态以及焦虑状态风险的对数比值［Log（Odds）］之间存在线性负相关。ROC曲线分析显示，HRR预测POD的ROC曲线下面积（AUC）为0.702（95%CI 0.629～0.774）、预测抑郁状态的AUC为0.650（95%CI 0.584～0.715）、预测焦虑状态的AUC为0.611（95%CI 0.542～0.680）。
结论： 术前HRR与老年患者胃肠肿瘤手术POD、焦虑以及抑郁状态的发生存在明显负相关，可作为潜在的辅助预测指标。
英文摘要:
      
Objective: To investigate the correlation between the preoperative hemoglobin-to-red cell distribution width ratio (HRR) and the incidence of postoperative delirium (POD), anxiety, and depression symptom in elderly patients undergoing gastrointestinal tumor surgery.
Methods: Clinical data of elderly patients who underwent elective gastrointestinal tumor surgery between April 2020 and April 2022 were retrospectively analyzed. Preoperative hemoglobin (Hb) and red cell distribution width (RDW) levels were recorded. The primary outcome was POD within 7 days postoperatively, assessed using the 3-minute diagnostic interview for CAM (3D-CAM). Secondary outcomes included postoperative anxiety and depression within 7 days, evaluated using the generalized anxiety disorder-7 (GAD-7) and patient health Questionnaire-9 (PHQ-9), respectively. Logistic regression was used to analyze the association between HRR and outcomes, while restricted cubic spline (RCS) analysis explored potential nonlinear relationships. Receiver operating characteristic (ROC) curves assessed the predictive performance of HRR.
Results: A total of 345 patients were included, with 60 patients (17.4%) developing POD, 75 patients (21.4%) experiencing postoperative depression, and 91 patients (26.4%) exhibiting postoperative anxiety. After adjusting for age, BMI, preoperative anxiety and depression status, preoperative Hb, RDW, white blood cell count, albumin level, intraoperative blood loss volume, and blood transfusion status, multivariate Logistic regression analysis revealed significant negative associations between HRR and POD (OR = 0.62, 95% CI 0.51-0.73, P < 0.001), depression (OR = 0.76, 95% CI 0.63-0.91, P = 0.003), and anxiety (OR = 0.77, 95% CI 0.66-0.92, P = 0.003). RCS analysis confirmed linear negative relationships between HRR and the log-odds of POD, depression, and anxiety. ROC analysis showed HRR had moderate predictive value: AUC for POD was 0.702 (95% CI 0.629-0.774), for depression 0.650 (95% CI 0.584-0.715), and for anxiety 0.611 (95% CI 0.542-0.680).
Conclusion: Preoperative HRR is significantly and linearly negatively associated with POD, anxiety, and depression in elderly patients undergoing gastrointestinal tumor surgery, suggesting its potential as an auxiliary predictive marker.
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