Abstract：
BACKGROUND: The risk of surgery and postoperative complications increases greatly in frail older patients with sarcopenia. The purpose of this study is to explore the correlation between myostatin (MSTN) levels and cognitive function and postoperative pulmonary complications (PPCs) in older patients undergoing thoracoscopic lobectomy and to determine whether MSTN could be used to predict the risk of postoperative complications and cognitive impairment.
METHODS: A prospective observational study was conducted at the First Affiliated Hospital of Bengbu Medical College, China, between January 2023 and June 2023. The risk factors of PPCs and postoperative cognitive impairment were studied using backward stepwise logistic regression analysis. The independent factors were formed into a linear regression equation to construct a risk score model for each patient. The 122 patients who participated in the study were divided into two groups, a low-level group and a high-level group, based on an MSTN level cut-off; the preoperative MSTN cut-off values was 25.55 ng/mL for cognitive dysfunction and 22.29 ng/mL for PPCs. The PPCs and cognitive function of the groups were compared.
RESULTS: Preoperative MSTN was confirmed as a risk factor for postoperative cognitive dysfunction and PPCs. After surgery, the proportion of patients with cognitive impairment in the high-level group was significantly higher than in the low-level group (P < 0.001). In the high-level group, the incidence of respiratory tract infections was 17.9% higher (P = 0.021), hypoxaemia was 20.5% higher (P = 0.001) and respiratory failure was 14.4% higher (P = 0.012) than in the low-level group. In addition, a high level of MSTN increased the length of hospital stay (P < 0.001) and decreased the Barthel Index score (P < 0.001).
CONCLUSIONS: The study findings suggest that MSTN could be used as an index to predict complications and cognitive impairment after thoracoscopic lobectomy in older patients with sarcopenia and to provide evidence for reducing postoperative cognitive impairment and PPCs.
METHODS: A prospective observational study was conducted at the First Affiliated Hospital of Bengbu Medical College, China, between January 2023 and June 2023. The risk factors of PPCs and postoperative cognitive impairment were studied using backward stepwise logistic regression analysis. The independent factors were formed into a linear regression equation to construct a risk score model for each patient. The 122 patients who participated in the study were divided into two groups, a low-level group and a high-level group, based on an MSTN level cut-off; the preoperative MSTN cut-off values was 25.55 ng/mL for cognitive dysfunction and 22.29 ng/mL for PPCs. The PPCs and cognitive function of the groups were compared.
RESULTS: Preoperative MSTN was confirmed as a risk factor for postoperative cognitive dysfunction and PPCs. After surgery, the proportion of patients with cognitive impairment in the high-level group was significantly higher than in the low-level group (P < 0.001). In the high-level group, the incidence of respiratory tract infections was 17.9% higher (P = 0.021), hypoxaemia was 20.5% higher (P = 0.001) and respiratory failure was 14.4% higher (P = 0.012) than in the low-level group. In addition, a high level of MSTN increased the length of hospital stay (P < 0.001) and decreased the Barthel Index score (P < 0.001).
CONCLUSIONS: The study findings suggest that MSTN could be used as an index to predict complications and cognitive impairment after thoracoscopic lobectomy in older patients with sarcopenia and to provide evidence for reducing postoperative cognitive impairment and PPCs.
摘要：
背景：在虚弱的老年少肌症患者中，手术和术后并发症的风险大大增加。目的探讨胸腔镜肺叶切除术老年患者肌肉生长抑制素(MSTN)水平与认知功能及术后肺部并发症(PPCs)的相关性,探讨MSTN能否用于预测术后并发症及认知障碍的风险。
方法：在蚌埠医学院第一附属医院进行前瞻性观察研究,中国,2023年1月至2023年6月。采用反向逐步logistic回归分析PPC与术后认知功能障碍的危险因素。将独立因素形成线性回归方程，构建每位患者的风险评分模型。参加研究的122名患者被分为两组，低级别的小组和高级别的小组，基于MSTN水平截止值;术前认知功能障碍的MSTN截止值是25.55ng/mL,PPC的MSTN截止值是22.29ng/mL.比较各组的PPC和认知功能。
结果：术前MSTN被证实是术后认知功能障碍和PPC的危险因素。手术后,高水平组认知障碍患者比例明显高于低水平组(P<0.001)。在高级别小组中，呼吸道感染的发生率高出17.9%(P=0.021),低氧血症比低水平组高20.5%(P=0.001),呼吸衰竭高14.4%(P=0.012).此外,高水平的MSTN可增加住院时间(P<0.001),降低Barthel指数评分(P<0.001).
结论：研究结果表明，MSTN可作为预测老年肌少症患者胸腔镜肺叶切除术后并发症和认知障碍的指标，为降低术后认知障碍和PPCs提供依据。
方法：在蚌埠医学院第一附属医院进行前瞻性观察研究,中国,2023年1月至2023年6月。采用反向逐步logistic回归分析PPC与术后认知功能障碍的危险因素。将独立因素形成线性回归方程，构建每位患者的风险评分模型。参加研究的122名患者被分为两组，低级别的小组和高级别的小组，基于MSTN水平截止值;术前认知功能障碍的MSTN截止值是25.55ng/mL,PPC的MSTN截止值是22.29ng/mL.比较各组的PPC和认知功能。
结果：术前MSTN被证实是术后认知功能障碍和PPC的危险因素。手术后,高水平组认知障碍患者比例明显高于低水平组(P<0.001)。在高级别小组中，呼吸道感染的发生率高出17.9%(P=0.021),低氧血症比低水平组高20.5%(P=0.001),呼吸衰竭高14.4%(P=0.012).此外,高水平的MSTN可增加住院时间(P<0.001),降低Barthel指数评分(P<0.001).
结论：研究结果表明，MSTN可作为预测老年肌少症患者胸腔镜肺叶切除术后并发症和认知障碍的指标，为降低术后认知障碍和PPCs提供依据。
