Unidad de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.
Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.
Arch Med Res. 2019 Nov;50(8):477-483. doi: 10.1016/j.arcmed.2019.11.002. Epub 2020 Feb 1.
Delirium has important etiological, prognostic, and therapeutic implications. The study of neurochemical markers in this condition is relevant to the understanding of its pathophysiology. The assessment of the dopamine system is particularly relevant, as dopamine antagonists are the most used drugs in delirium.
To analyze neurotransmission markers in patients with delirium, focusing in the dopamine metabolite, homovanillic acid.
A case-control study was performed at the National Institute of Neurology and Neurosurgery, Mexico, including hospitalized patients in which lumbar puncture was obtained for diagnostic purposes. Cases were selected if they fulfilled DSM-5 criteria for delirium. Age-paired controls were patients in which delirium was ruled out, selected at the same clinical scenario, during the same period. Neurological and systemic diagnoses were registered. Delirium was assessed using the DRS-98-R instrument. The dopamine metabolite, homovanillic acid (HVA), was measured by means of high-performance liquid chromatography. Other neurotransmission markers were also measured (5-hydroxyindoleacetic acid, glutamate, aspartate, GABA, glycine, arginine, citrulline, nitrites, and nitrates). A logistic regression model was used to determine pathogenic factors associated with the presence of delirium.
68 neurological patients with delirium and 68 patients without delirium were included. Higher homovanillic acid levels in cerebrospinal fluid were significantly associated with delirium. This result was significant after a subanalysis in patients without exposure to antipsychotics. Male gender and autoimmune limbic encephalitis were also associated with the presence of delirium.
In hospitalized neurological patients, dopaminergic hyperactivity and autoimmune limbic encephalitis are pathogenic factors associated with the presence of delirium.
谵妄具有重要的病因学、预后和治疗意义。研究这种情况下的神经化学标志物与理解其病理生理学有关。评估多巴胺系统尤为重要，因为多巴胺拮抗剂是谵妄最常用的药物。
分析谵妄患者的神经递质标志物，重点关注多巴胺代谢物——高香草酸。
在墨西哥国家神经病学与神经外科学院进行了一项病例对照研究，纳入因诊断目的而行腰椎穿刺的住院患者。如果患者符合 DSM-5 谵妄标准，则选择为病例。年龄匹配的对照患者为在同一临床情况下、同一时期排除谵妄的患者。记录了神经和系统诊断。使用 DRS-98-R 工具评估谵妄。通过高效液相色谱法测量多巴胺代谢物——高香草酸（HVA）。还测量了其他神经递质标志物（5-羟吲哚乙酸、谷氨酸、天冬氨酸、GABA、甘氨酸、精氨酸、瓜氨酸、亚硝酸盐和硝酸盐）。使用逻辑回归模型确定与谵妄发生相关的致病因素。
纳入了 68 例患有谵妄的神经科患者和 68 例无谵妄的患者。脑脊液中高香草酸水平升高与谵妄显著相关。在未接触抗精神病药物的患者中进行亚分析后，这一结果仍然显著。男性性别和自身免疫性边缘性脑炎也与谵妄的发生相关。
在住院的神经科患者中，多巴胺能活性亢进和自身免疫性边缘性脑炎是与谵妄发生相关的致病因素。
