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目的:评价体力活动(PA)与膝或髋关节置换术老年患者术后谵妄(POD)的关系。方法:基于围术期神经认知障碍和生物标志物生活方式队列，属于巢式病例对照研究。收集2022年8月至2023年8月在青岛市市立医院于脊椎-硬膜外麻醉下行择期膝或髋关节置换术老年患者病历资料，依据是否发生POD将其分为POD组( n＝89)和非POD组( n＝221)。术前抽取外周血标本，脊椎-硬膜外麻醉穿刺成功后抽取脑脊液(CSF)2 ml，采用ELISA法测定β淀粉样蛋白42(Aβ 42)、总tau蛋白(t-tau)及磷酸化tau蛋白(p-tau)浓度。logistics回归法筛选POD的影响因素，进行CSF生物标志物的中介效应分析。 结果:logistic回归校正高血压、糖尿病、饮酒史、受教育年限和MMSE评分等多项混杂因素后，结果显示，CSF Aβ 42浓度升高( OR＝0.997， P＝0.006)、Aβ 42/t-tau比值升高( OR＝0.642， P＝0.003)、Aβ 42/p-tau比值升高( OR＝0.872， P＝0.001)和PA( OR＝0.374， P＝0.001)为老年患者POD的保护因素，t-tau浓度升高( OR＝1.006， P＝0.001)和p-tau浓度升高( OR＝1.030， P＝0.011)是膝或髋关节置换术老年患者POD的危险因素。中介效应显示，PA与老年患者POD的关系由Aβ 42浓度(20%)、t-tau浓度(16%)、Aβ 42/t-tau比值(23%)和Aβ 42/p-tau比值(28%)介导。 结论:PA是膝或髋关节置换术老年患者POD的保护因素，其可能通过CSF生物标志物发挥中介效应预防POD发生。

Objective:To evaluate the relationship between physical activity (PA) and postoperative delirium (POD) in elderly patients undergoing knee or hip arthroplasty.Methods:The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort, which was a nested case-control study. Medical records from elderly patients undergoing elective knee or hip arthroplasty under spinal-epidural anesthesia at Qingdao Municipal Hospital from August 2022 to August 2023 were collected. The patients were divided into a POD group ( n=89) and a non-POD group ( n=221) based on the occurrence of POD. Peripheral blood samples were collected before surgery, and the cerebrospinal fluid (CSF) 2 ml was extracted after successful puncture under spinal-epidural anesthesia for determination of the concentrations of amyloid-β 42 (Aβ 42), total tau protein (t-tau), and phosphorylated tau protein (p-tau) by enzyme-linked immunosorbent assay. Logistic regression was used to analyze the influencing factors of POD, and the mediation analysis was conducted to examine the mediating role of CSF biomarker in the relationship between PA and POD. Results:Logistic regression analysis showed that the increased concentration of CSF biomarkers Aβ 42 ( OR=0.997, P=0.006), elevated ratio of Aβ 42/t-tau ( OR=0.642, P=0.003), elevated ratio of Aβ 42/p-tau ratio ( OR=0.872, P=0.001) and PA ( OR=0.374, P=0.001) were protective factors for POD, while the elevated concentrations of t-tau ( OR=1.006, P=0.001) and p-tau ( OR=1.030, P=0.011) were risk factors for POD after adjusting for multi-confounders such as hypertension, diabetes, history of drinking, years of education and Mini-Mental State Examination score. The results of the mediation analysis showed that Aβ 42 (20%), t-tau (16%), Aβ 42/t-tau (23%) and Aβ 42/p-tau (28%) played mediating roles in the relationship between PA and POD. Conclusions:PA is a protective factor for POD in elderly patients undergoing knee or hip arthroplasty and CSF biomarkers may play a mediating role in the relationship between PA and POD.