髋部骨折伴有和不伴有谵妄患者的血浆褪黑素水平：一项验证性研究。

Plasma melatonin levels in hip fracture patients with and without delirium: A confirmation study.

机构信息

Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.

Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands; University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.

出版信息

Mech Ageing Dev. 2017 Oct;167:1-4. doi: 10.1016/j.mad.2017.08.016. Epub 2017 Sep 8.

DOI:10.1016/j.mad.2017.08.016

PMID:28855142

Abstract

BACKGROUND

Melatonin plays a major role in maintaining circadian rhythm. Changes in melatonin metabolism might lead to circadian rhythm disturbances which are often observed in delirious patients.

AIM

To assess if high morning plasma melatonin concentrations were associated with delirium.

METHODS

Consecutive hip fracture patients aged ≥65 years were included. Delirium was assessed daily with the Confusion Assessment METHOD: Blood samples were collected at 11.00am on weekdays during first week of hospitalization. Melatonin was analyzed by liquid chromatography-tandem mass spectrometry.

RESULTS

We analyzed 389 samples of 144 participants [mean age 84.0, 70 experienced delirium]. A Generalized Estimating Equations (GEE) model with outcome melatonin level in highest tertile ( >3.36 pg/ml) and covariates delirium group (i.e. never, before, during, post delirium), cognitive impairment, age, sex and anesthesia type, was constructed. Highest melatonin levels were associated with postoperative samples (Odds Ratio(OR) 2.11 compared to preoperative samples; 95% Confidence Interval(CI) 1.17-3.82, p=0.01) and higher age (OR 1.05 per year; CI 1.01-1.11, p=0.03), but not with delirium group(p=0.35).

CONCLUSION

Undergoing surgery and aging in general may induce changes in melatonin metabolism. Future research should focus on daily multiple melatonin measurements to determine whether melatonin supplementation might be beneficial for delirium treatment or prevention.

摘要

背景

褪黑素在维持昼夜节律中起着重要作用。褪黑素代谢的变化可能导致昼夜节律紊乱，而这种紊乱在谵妄患者中经常观察到。

目的

评估清晨血浆褪黑素浓度升高是否与谵妄有关。

方法

连续纳入年龄≥65 岁的髋部骨折患者。使用意识混乱评估方法（Confusion Assessment Method）每天评估谵妄情况：在住院第一周的工作日上午 11 点采集血液样本。通过液相色谱-串联质谱法分析褪黑素。

结果

我们分析了 144 名参与者的 389 个样本[平均年龄 84.0 岁，70 名经历了谵妄]。构建了一个以结局为最高三分位（ >3.36 pg/ml）的广义估计方程（GEE）模型，并纳入了协变量谵妄组（即从未发生、术前、术中、术后谵妄）、认知障碍、年龄、性别和麻醉类型。最高褪黑素水平与术后样本相关（与术前样本相比，优势比（OR）为 2.11；95%置信区间（CI）为 1.17-3.82，p=0.01），与年龄较大相关（每年增加 1.05；CI 为 1.01-1.11，p=0.03），但与谵妄组无关（p=0.35）。