Liu Xingyang, Wang Yanfeng, Wu Jinghan, Ye Chunyan, Ma Daqing, Wang E
Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Front Med (Lausanne). 2023 Jul 28;10:1107369. doi: 10.3389/fmed.2023.1107369. eCollection 2023.
Neuroinflammation and neuronal injury have been reported to be associated with the development of postoperative delirium in both preclinical and clinical settings. This study aimed to investigate the potential correlation between biomarkers of neurofilament light chain and glial fibrillary acidic protein and emergence and postoperative delirium in elderly patients undergoing surgery.
Patients who developed emergence delirium ( = 30) and postoperative delirium ( = 32), along with their matched controls, were enrolled after obtaining ethics approval and written informed consent. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit or Confusion Assessment Method scale, and blood samples were collected before and after surgery for plasma neurofilament light chain and glial fibrillary acidic protein measurements using a single-molecule array.
The study found that in patients with emergence delirium, the increase in plasma neurofilament light chain protein levels during surgery was significantly higher than in non-delirium patients ( = 0.002). Additionally, in patients with postoperative delirium, both the increase in plasma neurofilament light chain protein levels ( < 0.001) and the increase in plasma glial fibrillary acidic protein levels during surgery ( = 0.008) were significantly higher than in non-delirium patients. Multivariate logistic regression analysis showed that the increase in plasma neurofilament light chain protein was associated with emergence delirium (adjusted OR = 1.872, = 0.005), and the increase in plasma glial fibrillary acidic protein was associated with postoperative delirium (adjusted OR = 1.419, = 0.016). Moreover, the American Society of Anesthesiologists Physical Status Classification and surgical duration were also found to be associated with delirium in elderly patients.
Our findings suggest that emergence delirium is linked to elevated levels of neurofilament light chain, a biomarker of axonal injury, during surgery. Furthermore, in addition to axonal injury, postoperative delirium was also associated with an increase in glial fibrillary acidic protein, a marker of astrocyte activation.
在临床前和临床环境中，神经炎症和神经元损伤均被报道与术后谵妄的发生有关。本研究旨在调查神经丝轻链和胶质纤维酸性蛋白生物标志物与老年手术患者苏醒期及术后谵妄之间的潜在相关性。
在获得伦理批准和书面知情同意后，纳入发生苏醒期谵妄（n = 30）和术后谵妄（n = 32）的患者及其匹配的对照组。使用重症监护病房意识模糊评估方法或意识模糊评估量表评估谵妄情况，并在手术前后采集血样，采用单分子阵列法检测血浆神经丝轻链和胶质纤维酸性蛋白。
研究发现，苏醒期谵妄患者手术期间血浆神经丝轻链蛋白水平的升高显著高于非谵妄患者（P = 0.002）。此外，术后谵妄患者手术期间血浆神经丝轻链蛋白水平的升高（P < 0.001）和血浆胶质纤维酸性蛋白水平的升高（P = 0.008）均显著高于非谵妄患者。多因素逻辑回归分析显示，血浆神经丝轻链蛋白的升高与苏醒期谵妄相关（调整后的比值比 = 1.872，P = 0.005），血浆胶质纤维酸性蛋白的升高与术后谵妄相关（调整后的比值比 = 1.419，P = 0.016）。此外，还发现美国麻醉医师协会身体状况分级和手术时长也与老年患者的谵妄有关。
我们的研究结果表明，苏醒期谵妄与手术期间轴突损伤生物标志物神经丝轻链水平升高有关。此外，除轴突损伤外，术后谵妄还与星形胶质细胞激活标志物胶质纤维酸性蛋白的增加有关。
