目的 探讨血清可溶性分化簇22（sCD22）与可溶性分化簇40配体（sCD40L）联合检测对老年骨科大手术（MOS）患者术后谵妄（POD）的预测价值。 方法 选取2024年1月至2025年10月在医院行手术治疗的老年MOS患者225例，采用酶联免疫吸附法检测血清sCD22、sCD40L水平。老年MOS患者术后7 d根据是否发生POD分为POD组和非POD组，采用多因素logistic回归分析老年MOS患者POD的影响因素，ROC曲线和决策曲线分析血清sCD22、sCD40L水平对老年MOS患者POD的预测价值及临床效益。 结果 225例老年MOS患者POD发生率为18.67%（42/225）。与非POD组比较，POD组年龄、美国麻醉医师协会（ASA）分级、术中出血量、术中输液量增加，手术时间延长，C反应蛋白（CRP）、sCD22、sCD40L水平升高（P < 0.05）。年龄增加（OR = 1.109，95%CI：1.014 ~ 1.213，P = 0.023）、ASA分级Ⅲ—Ⅳ级（OR = 5.400，95%CI：1.345 ~ 21.681，P = 0.017）、术中输液量增加（OR = 1.120，95%CI：1.007 ~ 1.247，P = 0.038）、CRP升高（OR = 1.197，95%CI：1.055 ~ 1.358，P = 0.005）、sCD22升高（OR = 1.219，95%CI：1.094 ~ 1.359，P < 0.001）、sCD40L升高（OR = 3.328，95%CI：2.003 ~ 5.529，P < 0.001）为老年MOS患者POD的独立危险因素。ROC曲线显示，血清sCD22、sCD40L水平及二者联合预测老年MOS患者POD的曲线下面积为0.797、0.804、0.907，敏感度分别为0.691、0.548、0.762，特异度分别为0.869、0.978、0.940，二者联合的预测价值优于血清sCD22、sCD40L水平单独预测（P < 0.05）；决策曲线显示，在阈值概率0.05 ~ 0.10范围内，血清sCD22、sCD40L水平联合预测老年MOS患者POD的净效益大于血清sCD22、sCD40L水平单独预测。 结论 血清sCD22、sCD40L水平升高为老年MOS患者POD的独立危险因素，二者联合对老年MOS患者POD的预测价值较高。

Objective To evaluate the predictive value of serum soluble cluster of differentiation 22 （sCD22） and soluble CD40 ligand （sCD40L） for postoperative delirium （POD） among elderly patients who undergo major orthopedic surgery （MOS）. Methods A total of 225 elderly patients who underwent MOS at our hospital from January 2024 to October 2025 were included in the study. The levels of serum sCD22 and sCD40L were measured using enzyme-linked immunosorbent assay （ELISA）. The patients were divided into the POD group and the non-POD group based on the occurrence of POD within 7 days after the surgery. Multivariate logistic regression analysis was carried out to identify the factors related to POD. Receiver operating characteristic （ROC） curve analysis and decision curve analysis （DCA） were performed to evaluate the predictive performance and clinical utility of serum sCD22 and sCD40L levels. Results POD occurred in 42 out of 225 patients （18.67%）. In comparison with the non-POD group， patients who developed POD were characterized by an older age， a higher American Society of Anesthesiologists （ASA） grade， a greater amount of intraoperative blood loss and fluid administration， a longer operative duration， and higher levels of C-reactive protein （CRP）， sCD22， and sCD40L （P < 0.05）. Multivariate logistic regression analysis identified advanced age （OR = 1.109， 95%CI： 1.014 ? 1.213， P = 0.023）， ASA grade Ⅲ ? Ⅳ （OR = 5.400， 95%CI： 1.345 ? 21.681， P = 0.017）， an increased amount of intraoperative fluid administration （OR = 1.120， 95%CI： 1.007 ? 1.247， P = 0.038）， elevated CRP （OR = 1.197， 95%CI： 1.055 ? 1.358， P = 0.005）， elevated sCD22 （OR = 1.219， 95%CI： 1.094 ? 1.359， P < 0.001）， and elevated sCD40L （OR = 3.328， 95%CI： 2.003 ? 5.529， P < 0.001） as independent risk factors for POD. The areas under the ROC curve for predicting POD were 0.797 for sCD22， 0.804 for sCD40L， and 0.907 for their combined assessment， with corresponding sensitivities of 0.691， 0.548， and 0.762 and specificities of 0.869， 0.978， and 0.940， respectively. The combined model demonstrated significantly greater predictive performance than either biomarker alone （P < 0.05）. DCA further demonstrated that the combined assessment yielded a greater net clinical benefit than either individual marker across a threshold probability range of 0.05 ? 0.10. Conclusions Elevated serum levels of sCD22 and sCD40L are independent risk factors for POD in elderly patients undergoing MOS. A combined assessment of these two biomarkers exhibits superior predictive performance and can serve as a valuable tool for the early identification of patients at high risk of POD.