Ko Haein, Kayumov Mukhammad, Lee Kyo Seon, Oh Sang Gi, Na Kook Joo, Jeong In Seok
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
J Chest Surg. 2024 May 5;57(3):263-271. doi: 10.5090/jcs.23.159. Epub 2024 Mar 13.
Delirium is a recognized neurological complication following cardiac surgery and is associated with adverse clinical outcomes, including elevated mortality and prolonged hospitalization. While several clinical risk factors for post-cardiac surgery delirium have been identified, the pathophysiology related to the immune response remains unexamined. This study was conducted to investigate the immunological factors contributing to delirium in patients after thoracic aortic surgery.
We retrospectively evaluated 43 consecutive patients who underwent thoracic aortic surgery between July 2017 and June 2018. These patients were categorized into 2 groups: those with delirium and those without it. All clinical characteristics were compared between groups. Blood samples were collected and tested on the day of admission, as well as on postoperative days 1, 3, 7, and 30. Levels of helper T cells (CD4), cytotoxic T cells (CD8), B cells (CD19), natural killer cells (CD56+CD16++), and monocytes (CD14+CD16-) were measured using flow cytometry.
The median patient age was 71 years (interquartile range, 56.7 to 79.0 years), and 21 of the patients (48.8%) were male. Preoperatively, most immune cell counts did not differ significantly between groups. However, the patients with delirium exhibited significantly higher levels of interleukin-6 and lower levels of tumor necrosis factor-alpha (TNF-α) than those without delirium (p<0.05). Multivariate analysis revealed that lower TNF-α levels were associated with an increased risk of postoperative delirium (p<0.05).
Postoperative delirium may be linked to perioperative changes in immune cells and preoperative cytokine levels. Additional research is required to elucidate the pathophysiological mechanisms underlying delirium.
谵妄是心脏手术后公认的神经并发症，与不良临床结局相关，包括死亡率升高和住院时间延长。虽然已经确定了一些心脏手术后谵妄的临床危险因素，但与免疫反应相关的病理生理学仍未得到研究。本研究旨在调查胸主动脉手术后患者谵妄的免疫因素。
我们回顾性评估了2017年7月至2018年6月期间连续接受胸主动脉手术的43例患者。这些患者分为两组：有谵妄组和无谵妄组。比较两组之间的所有临床特征。在入院当天以及术后第1、3、7和30天采集血样并进行检测。使用流式细胞术测量辅助性T细胞（CD4）、细胞毒性T细胞（CD8）、B细胞（CD19）、自然杀伤细胞（CD56+CD16++）和单核细胞（CD14+CD16-）的水平。
患者的中位年龄为71岁（四分位间距，56.7至79.0岁），其中21例患者（48.8%）为男性。术前，大多数免疫细胞计数在两组之间无显著差异。然而，与无谵妄的患者相比，有谵妄的患者白细胞介素-6水平显著升高，肿瘤坏死因子-α（TNF-α）水平较低（p<0.05）。多因素分析显示，较低的TNF-α水平与术后谵妄风险增加相关（p<0.05）。
术后谵妄可能与免疫细胞的围手术期变化和术前细胞因子水平有关。需要进一步研究以阐明谵妄的病理生理机制。
