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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 651 -656. doi: 10.3877/cma.j.issn.1674-6902.2026.04.018

论著

术前睡眠监测参数及血清NfL与慢性阻塞性肺疾病合并肺癌患者术后谵妄的相关性分析
吴皎卿1, 石进涛2, 胡玉萍1, 蒲嘉泽3, 张长文4, 李甜甜1, 张莹1, 卞春安5, 陈豪5, 杨玉春1,†()   
  1. 1210031　南京，南京医科大学第四附属医院麻醉科
    2210022　南京，南京中医药大学附属南京中医院
    3210031　南京，南京医科大学第四附属医院肿瘤内科
    4210031　南京，南京医科大学第四附属医院呼吸与危重症医学科
    5210031　南京，南京医科大学第四附属医院胸外科
  • 收稿日期:2025-10-13 出版日期:2026-08-25
  • 通信作者: 杨玉春

Correlation between preoperative sleep monitoring parameters and serum NfL with postoperative delirium in patients with chronic obstructive pulmonary disease complicated with lung cancer

Jiaoqing Wu1, Jintao Shi2, Yuping Hu1, Jiaze Pu3, Changwen Zhang4, Tiantian Li1, Ying Zhang5, Chunan Bian5, Hao Chen5, Yuchun Yang1,†()   

  1. 1Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, China
    2Department of Medical Oncology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, China
    3Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, China
    4Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, China
    5Department of Thoracic Surgery, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing 210031, China
  • Received:2025-10-13 Published:2026-08-25
  • Corresponding author: Yuchun Yang
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引用本文：

吴皎卿, 石进涛, 胡玉萍, 蒲嘉泽, 张长文, 李甜甜, 张莹, 卞春安, 陈豪, 杨玉春. 术前睡眠监测参数及血清NfL与慢性阻塞性肺疾病合并肺癌患者术后谵妄的相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(04): 651-656.

Jiaoqing Wu, Jintao Shi, Yuping Hu, Jiaze Pu, Changwen Zhang, Tiantian Li, Ying Zhang, Chunan Bian, Hao Chen, Yuchun Yang. Correlation between preoperative sleep monitoring parameters and serum NfL with postoperative delirium in patients with chronic obstructive pulmonary disease complicated with lung cancer[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(04): 651-656.

目的

探讨术前睡眠监测参数及血清神经丝轻链蛋白(neurofilament light polypeptide, NfL)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并肺癌患者术后谵妄(postoperative delirium, POD)的相关性。

方法

选取2021年1月至2025年8月我院接受胸腔镜肺叶切除术的COPD合并肺癌患者87例，发生POD 19例分为观察组，未发生POD 68例分为对照组。收集临床资料、实验室检测指标、术前多导睡眠监测数据及术中参数。采用多因素Logistic回归分析POD的影响因素，绘制受试者工作特征(receiver operating characteristic, ROC)曲线，判断预测。

结果

观察组年龄、美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级Ⅲ级占比、术中单肺通气时间[(97.85±16.37)min比(88.14±16.05)min，P＝0.001]、丙泊酚用量[(790.34±68.34)mg比(648.14±68.91)mg，P<0.001]及血清NfL[(77.45±22.36)pg/ml比(61.34±10.02)pg/ml，P<0.001]高于对照组。观察组REM睡眠缺失率(73.68%比47.06%，P<0.05)和非典型睡眠率(47.37%比17.65%，P<0.05)高于对照组。多因素Logistic回归分析显示，术中单肺通气时间(OR＝1.063，95%CI：1.035~1.093，P<0.001)、丙泊酚用量(OR＝1.006，95%CI: 1.003~1.009，P<0.001)、血清NfL(OR＝1.397，95%CI: 1.182~1.652，P<0.001)、快速眼动期(rapid eye movement, REM)睡眠缺失(OR＝2.294，95%CI: 1.164~4.519，P＝0.016)和非典型睡眠(OR＝1.178，95%CI: 1.050~1.635，P＝0.008)为POD的危险因素。ROC曲线分析显示，血清NfL、REM睡眠缺失、丙泊酚用量、非典型睡眠、术中单肺通气时间的曲线下面积(area under the curve, AUC)分别为0.757、0.602、0.762、0.778、0.763；联合参数(睡眠参数＋NfL＋术中单肺通气时间＋丙泊酚用量)的AUC达0.939(95%CI: 0.898~0.981)，约登指数为0.758。

结论

术前血清NfL升高、REM睡眠缺失、非典型睡眠、术中单肺通气时间延长及丙泊酚用量增加是COPD合并肺癌患者胸腔镜术后发生POD的危险因素。将术前睡眠参数与血清NfL联合预测POD具有临床意义。

关键词: 肺疾病，慢性阻塞性, 支气管肺癌, 睡眠监测参数, 血清神经丝轻链蛋白, 术后谵妄
Objective

To investigate the correlation between preoperative sleep monitoring parameters and serum neurofilament light polypeptide (NfL) with postoperative delirium (POD) in patients with chronic obstructive pulmonary disease (COPD) complicated with lung cancer.

Methods

A total of 87 patients with COPD and lung cancer who underwent thoracoscopic lung resection in our hospital from January 2021 to August 2025 were enrolled. Among them, 19 patients who developed POD were assigned to the observation group, and 68 patients without POD were assigned to the control group. Clinical data, laboratory indicators, preoperative polysomnographic parameters, and intraoperative parameters were collected. Multivariate logistic regression was used to identify independent risk factors for POD, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of each parameter and their combination.

Results

The observation group had significantly higher age, proportion of American Society of Anesthesiologists (ASA) grade Ⅲ, intraoperative onelung ventilation time [(97.85±16.37) min vs. (88.14±16.05) min, P=0.001], propofol dosage [(790.34±68.34) mg vs. (648.14±68.91) mg, P<0.001], and serum NfL level [(77.45±22.36) pg/ml vs. (61.34±10.02) pg/ml, P<0.001] than the control group. The rates of REM sleep absence (73.68% vs. 47.06%, P<0.05) and atypical sleep (47.37% vs. 17.65%, P<0.05) were also significantly higher in the observation group. Multivariate logistic regression showed that intraoperative onelung ventilation time (OR=1.063, 95%CI: 1.035~1.093, P<0.001), propofol dosage (OR=1.006, 95%CI: 1.003~1.009, P<0.001), serum NfL (OR=1.397, 95%CI: 1.182~1.652, P<0.001), rapid eye movement (REM )sleep absence (OR=2.294, 95%CI: 1.164~4.519, P=0.016), and atypical sleep (OR=1.178, 95%CI: 1.050~1.635, P=0.008) were independent risk factors for POD. ROC curve analysis revealed that the area under the curve (AUC) values for serum NfL, REM sleep absence, propofol dosage, atypical sleep, and onelung ventilation time were 0.757, 0.602, 0.762, 0.778, and 0.763, respectively. The combined model incorporating sleep parameters, NfL, onelung ventilation time, and propofol dosage yielded an AUC of 0.939 (95%CI: 0.898~0.981) with a Youden index of 0.758.

Conclusions

Elevated preoperative serum NfL, REM sleep absence, atypical sleep, prolonged intraoperative onelung ventilation time, and increased propofol dosage are independent risk factors for POD in elderly COPD patients undergoing thoracoscopic lung cancer surgery. The combined preoperative assessment of sleep parameters and serum NfL demonstrates good predictive value for POD and may facilitate early identification of highrisk patients to guide perioperative brainprotective strategies.

Key words: Chronic obstructive pulmonary disease, Bronchogenic lung carcinoma, Sleep monitoring parameters, Serum neurofilament light polypeptide, Postoperative delirium
表1 两组COPD合并肺癌患者临床资料结果
临床资料 观察组(n＝19) 对照组(n＝68) Z/t/χ2值 P值
CCI[n(%)]     0.123 0.726
≥2分 13(68.42) 54(79.41)    
<2分 6(31.58) 14(20.59)    
合并症[n(%)]        
高血压 8(42.11) 35(51.47) 0.521 0.470
糖尿病 9(47.37) 30(44.12) 0.064 0.801
冠心病 5(26.32) 25(36.76) 0.718 0.397
吸烟史[n(%)] 11(57.89) 42(61.76) 0.093 0.760
饮酒史[n(%)] 12(63.16) 46(67.65) 0.135 0.714
ASA分级[n(%)]     2.143 0.143
Ⅱ级 12(63.16) 54(79.41)    
Ⅲ级 4(36.84) 14(20.59)    
PNI评分[n(%)]     0.012 0.912
50≥分 12(63.16) 42(61.76)    
<50分 4(36.84) 26(38.24)    
实验室指标(±s)        
术前总蛋白(g/L) 58.25±12.31 59.02±13.64 0.235 0.816
术前血红蛋白(g/L) 129.84±10.25 130.97±11.02 0.418 0.679
NfL(pg/ml) 77.45±22.36 61.34±10.02 －3.056 0.006
AST(IU/L) 25.34±7.97 26.34±7.25 0.493 0.626
ALT (IU/L) 27.43±9.01 28.46±8.93 0.441 0.662
总胆固醇(mmol/L) 5.71±1.31 5.68±1.19 －0.090 0.929
高密度脂蛋白(mmol/L) 1.18±0.37 1.14±0.32 －0.429 0.6672
低密度脂蛋白(mmol/L) 3.79±0.57 3.95±0.51 1.106 0.279
甘油三酯(mmol/L) 1.97±0.25 2.01±0.35 0.561 0.578
空腹血糖(mmol/L) 5.87±1.68 5.70±1.75 －0.386 0.702
图1 COPD合并肺癌患者典型影像学CT图
图2 COPD合并肺癌患者典型组织病理学检查图。图A为右下肺叶低分化腺癌；图B为左下肺叶腺癌Ⅲ级；图C为右肺中叶浸润性腺癌Ⅱ级伴气道播散及肉芽肿性炎；图D为右肺腺癌Ⅱ级
表2 两组COPD合并肺癌患者术中参数监测结果
术中参数监测 观察组(n＝19) 对照组(n＝68) Z/t/χ2值 P值
出血量[n(%)]     0.064 0.801
<200 ml 9(47.37) 30(44.12)    
≥200 ml 10(52.63) 39(55.88)    
麻醉剂(±s)        
丙泊酚(mg) 790.34±68.34 648.14±68.91 －8.004 0.000
舒芬太尼(μg) 105.57±8.35 104.58±5.97 －0.483 0.633
瑞芬太尼(μg) 1 325.36±98.15 1 318.02±105.78 －0.283 0.779
阿托品使用[n(%)] 5(26.32) 25(36.76) 0.718 0.400
麻醉时间[min, (±s)] 165.38±18.74 160.94±19.37 －0.930 0.361
单肺通气时间[min, (±s)] 97.85±16.37 88.14±16.05 －2.351 0.027
输液量[n(%)]     2.640 0.104
<2 000 ml 16(84.21) 44(64.71)    
≥2 000 ml 3(15.79) 24(35.29)    
术后镇痛泵[n(%)] 17(89.47) 47(69.12) 3.164 0.075
肺切除方式[n(%)]     1.925 0.588
楔形切除 4(21.05) 20(29.41)    
肺叶切除 7(36.84) 27(39.71)    
一侧全肺切除 1(5.27) 6(8.82)    
肺段切除 7(36.84) 15(20.06)    
表3 COPD合并肺癌术后POD发生多因素Logistic回归分析
影响因素 B 标准误差 瓦尔德 P值 OR 95%CI
下限 上限
年龄 －0.061 0.049 1.569 0.210 0.941 0.855 1.035
术中单肺通气时间 0.061 0.014 19.687 0.000 1.063 1.035 1.093
丙泊酚用量 0.006 0.002 15.141 0.000 1.006 1.003 1.009
ASA分级Ⅲ级 －0.416 0.669 0.387 0.534 0.659 0.178 2.447
NfL 0.335 0.086 15.303 0.000 1.397 1.182 1.652
REM睡眠缺失 0.830 0.346 5.757 0.016 2.294 1.164 4.519
非典型睡眠 1.724 0.648 7.076 0.008 1.178 1.050 1.635
常量 －41.712 8.499 24.085 0.000 0.000    
表4 COPD合并肺癌术后POD发生的ROC曲线分析
影响因素 AUC SE P值 约登指数 95%CI
下限 上限
NfL 0.757 0.0472 0.0001 0.483 0.690 0.816
REM睡眠缺失 0.602 0.0478 0.033 0.205 0.529 0.672
丙泊酚用量 0.762 0.0398 0.001 0.418 0.695 0.820
非典型睡眠 0.778 0.0405 0.001 0.556 0.713 0.835
术中单肺通气时间 0.763 0.0449 0.001 0.461 0.697 0.821
睡眠参数＋NfL 0.890 0.025 0.000 0.599 0.841 0.939
睡眠参数 0.811 0.035 0.000 0.557 0.743 0.879
术中单肺通气时间＋丙泊酚用量 0.846 0.037 0.000 0.616 0.774 0.918
联合参数 0.939 0.021 0.000 0.758 0.898 0.981
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