Department of Anaesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
Department of Pain and Palliative Medical Sciences, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Medicine (Baltimore). 2022 Jul 29;101(30):e29906. doi: 10.1097/MD.0000000000029906.
Postoperative delirium is a common complication for elderly patients. Detection of phosphorylated neurofilament heavy subunit in the serum reflects axonal damage with postoperative delirium. Although it has been implicated that serum apolipoprotein levels might be associated with senile cognitive disorder, its role in the development of delirium has not been fully investigated. This study examined the association of apolipoproteins with delirium after surgery. This was a post hoc analysis of 117 patients who participated in a prospective observational study of delirium in patients undergoing cancer surgery. Patients were clinically assessed for delirium within the first 5 days of surgery. Serum levels of apolipoprotein A-I, B, and E were measured on postoperative day 3. Forty-one patients (35%) were clinically diagnosed with postoperative delirium. Serum levels of apolipoprotein A-I and B were increased in patients with delirium whereas those of apolipoprotein E were decreased. These changes in apolipoprotein A-I and E levels were associated with the presence of phosphorylated neurofilament heavy subunit in the serum, and were significantly associated with delirium (A-I: adjusted odds ratio [aOR], 6.238; 95% confidence interval [CI], 2.766-20.68; P < .0001; E: aOR, 0.253; 95% CI, 0.066-0.810; P = .0193). A combination of apolipoprotein A-I and E offers significant discrimination between delirium and nondelirium with high accuracy (area under the curve, 0.8899). Serum apolipoprotein A-I and E levels were associated with delirium and the presence of phosphorylated neurofilament heavy subunit in serum. Therefore, apolipoproteins might be useful biomarkers of postoperative delirium.
术后谵妄是老年患者的常见并发症。血清中磷酸化神经丝重亚单位的检测反映了术后谵妄时的轴突损伤。尽管已经表明血清载脂蛋白水平可能与老年认知障碍有关，但它在谵妄发展中的作用尚未得到充分研究。本研究探讨了载脂蛋白与手术后谵妄的关系。这是对 117 名参与癌症手术患者谵妄前瞻性观察研究的患者进行的事后分析。患者在手术后的前 5 天内接受了谵妄的临床评估。在术后第 3 天测量了载脂蛋白 A-I、B 和 E 的血清水平。41 名患者（35%）被临床诊断为术后谵妄。谵妄患者的血清载脂蛋白 A-I 和 B 水平升高，而载脂蛋白 E 水平降低。载脂蛋白 A-I 和 E 水平的这些变化与血清中磷酸化神经丝重亚单位的存在有关，并且与谵妄显著相关（A-I：调整后的优势比[aOR]，6.238；95%置信区间[CI]，2.766-20.68；P<0.0001；E：aOR，0.253；95%CI，0.066-0.810；P=0.0193）。载脂蛋白 A-I 和 E 的组合在区分谵妄和非谵妄方面具有很高的准确性（曲线下面积，0.8899）。血清载脂蛋白 A-I 和 E 水平与谵妄以及血清中磷酸化神经丝重亚单位的存在有关。因此，载脂蛋白可能是术后谵妄的有用生物标志物。
