Vahdat Shariatpanahi Maryam, Velayati Aynaz, Jamalian Seyed Ali, Babevaynejad Mehdi, Vahdat Shariatpanahi Zahra
Department of Psychiatry, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Neuropsychiatr Dis Treat. 2019 May 23;15:1413-1419. doi: 10.2147/NDT.S201620. eCollection 2019.
It has been reported that cobalamin and folate deficiency is related to delirium in persons with dementia. We evaluated the association of admission serum levels of cobalamin, folic acid, and homocysteine with the occurrence of acute delirium after coronary artery bypass surgery. In this prospective cohort study, serum levels of cobalamin, folic acid, and homocysteine were measured for 296 patients upon admission. Delirium was defined by the confusion assessment method for the intensive care unit. Postoperative delirium was detected in 23% (n=68) of patients. Cobalamin deficiency, folate deficiency, and hyperhomocysteinemia were observed in 29% (n=86), 6% (n=18), and 68% (n=200) of patients, respectively. The mean ± SD serum levels of folic acid were 10.77±5.39 ng/mL and 12.86±6.51 ng/mL in delirium and non-delirium patients, respectively (=0.008). The median (interquartile range [IQR]) serum levels of cobalamin were 280 (216-351) and 247 (195.5-336) in delirium and non-delirium patients, respectively (=0.09). The median (IQR) serum levels of homocysteine were 18.5 (14.5-22.1) µmol/L and 17.33 (14.2-23.2) µmol/L in delirium and non-delirium patients, respectively (=0.94). Multivariate regression analysis adjusted by other risk factors indicated that serum homocysteine, folate, and cobalamin levels had no association with the occurrence of delirium. There was no relationship between the preoperative levels of cobalamin, folate, and homocysteine, and acute occurrence of delirium observed after cardiac surgery.
据报道，钴胺素和叶酸缺乏与痴呆患者的谵妄有关。我们评估了冠状动脉搭桥手术后入院时血清钴胺素、叶酸和同型半胱氨酸水平与急性谵妄发生之间的关联。在这项前瞻性队列研究中，对296例患者入院时的血清钴胺素、叶酸和同型半胱氨酸水平进行了测量。谵妄采用重症监护病房的意识模糊评估方法进行定义。23%（n=68）的患者发生了术后谵妄。分别有29%（n=86）、6%（n=18）和68%（n=200）的患者存在钴胺素缺乏、叶酸缺乏和高同型半胱氨酸血症。谵妄患者和非谵妄患者的叶酸平均±标准差血清水平分别为10.77±5.39 ng/mL和12.86±6.51 ng/mL（=0.008）。谵妄患者和非谵妄患者的钴胺素中位数（四分位间距[IQR]）血清水平分别为280（216 - 351）和247（195.5 - 336）（=0.09）。谵妄患者和非谵妄患者的同型半胱氨酸中位数（IQR）血清水平分别为18.5（14.5 - 22.1）µmol/L和17.33（14.2 - 23.2）µmol/L（=0.94）。经其他风险因素调整的多变量回归分析表明，血清同型半胱氨酸、叶酸和钴胺素水平与谵妄的发生无关。心脏手术后观察到的术前钴胺素、叶酸和同型半胱氨酸水平与谵妄的急性发作之间没有关系。
