Department of Neurology, Academic Medical Center/University of Amsterdam, PO box 22660, 1100 DD Amsterdam, the Netherlands.
J Neuroinflammation. 2013 Oct 7;10:122. doi: 10.1186/1742-2094-10-122.
Aging and neurodegenerative disease predispose to delirium and are both associated with increased activity of the innate immune system resulting in an imbalance between pro- and anti-inflammatory mediators in the brain. We examined whether hip fracture patients who develop postoperative delirium have altered levels of inflammatory mediators in cerebrospinal fluid (CSF) prior to surgery.
Patients were 75 years and older and admitted for surgical repair of an acute hip fracture. CSF samples were collected preoperatively. In an exploratory study, we measured 42 cytokines and chemokines by multiplex analysis. We compared CSF levels between patients with and without postoperative delirium and examined the association between CSF cytokine levels and delirium severity. Delirium was diagnosed with the Confusion Assessment Method; severity of delirium was measured with the Delirium Rating Scale Revised-98. Mann-Whitney U tests or Student t-tests were used for between-group comparisons and the Spearman correlation coefficient was used for correlation analyses.
Sixty-one patients were included, of whom 23 patients (37.7%) developed postsurgical delirium. Concentrations of Fms-like tyrosine kinase-3 (P=0.021), Interleukin-1 receptor antagonist (P=0.032) and Interleukin-6 (P=0.005) were significantly lower in patients who developed delirium postoperatively.
Our findings fit the hypothesis that delirium after surgery results from a dysfunctional neuroinflammatory response: stressing the role of reduced levels of anti-inflammatory mediators in this process.
The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient.
NCT00497978. Local ethical protocol number: NL16222.094.07.
衰老和神经退行性疾病易导致谵妄，并且两者都与固有免疫系统的活性增加有关，从而导致大脑中促炎和抗炎介质之间失衡。我们研究了接受髋关节手术后出现术后谵妄的患者在手术前是否有脑脊液（CSF）中炎症介质水平改变。
患者年龄在 75 岁及以上，因急性髋部骨折接受手术修复。在术前收集 CSF 样本。在一项探索性研究中，我们通过多重分析测量了 42 种细胞因子和趋化因子。我们比较了术后出现和未出现谵妄的患者的 CSF 水平，并研究了 CSF 细胞因子水平与谵妄严重程度之间的关联。采用意识模糊评估方法诊断谵妄；采用修订后的 98 项谵妄评定量表测量谵妄严重程度。采用 Mann-Whitney U 检验或 Student t 检验进行组间比较，采用 Spearman 相关系数进行相关性分析。
共纳入 61 例患者，其中 23 例（37.7%）术后出现谵妄。术后发生谵妄的患者中，Fms 样酪氨酸激酶 3（Fms-like tyrosine kinase-3，Flt3）（P=0.021）、白细胞介素-1 受体拮抗剂（interleukin-1 receptor antagonist，IL-1Ra）（P=0.032）和白细胞介素-6（interleukin-6，IL-6）（P=0.005）的浓度显著降低。
我们的发现符合术后谵妄是由神经炎症反应功能障碍引起的假说：强调了抗炎介质水平降低在该过程中的作用。
牛磺酸对老年髋部骨折患者发病率和死亡率的影响。
NCT00497978。当地伦理协议编号：NL16222.094.07。
