Sugita-Yamaguchi Yurina, Miyazaki Tetsuro, Shimada Kazunori, Shimizu Megumi, Ouchi Shohei, Aikawa Tatsuro, Shiozawa Tomoyuki, Takasu Kiyoshi, Hiki Masaru, Takahashi Shuhei, Sumiyoshi Katsuhiko, Minamino Tohru
Department of Biology and Cardiovascular Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo 113-8421, Japan.
Laboratory of Bioregulatory Clinical Pharmacology, Faculty of Pharmacy, Juntendo University, 6-8-1 Hinode, Urayasu 279-0013, Japan.
Nutrients. 2025 Jun 11;17(12):1979. doi: 10.3390/nu17121979.
Delirium is frequently observed in patients admitted to the intensive care unit, and is associated with mortality and morbidity. Although several studies have reported an association between polyunsaturated fatty acids (PUFAs) and cognitive disorders, the association between PUFA levels and development of delirium in patients with acute cardiovascular disease remains unknown. This study aimed to clarify the association between PUFA levels and development of delirium in the coronary intensive care unit (CICU). We enrolled 590 consecutive patients (mean age, 70 ± 14 years) admitted to the CICU of Juntendo University Hospital. Fasting serum PUFA levels were measured within 24 h of admission. Delta-5 desaturase activity was estimated as the ratio of arachidonic acid (AA) to dihomo-gamma-linolenic acid (DGLA). Furthermore, delirium was defined as patients having a delirium score of ≥4 using the Intensive Care Delirium Screening Checklist. Delirium was observed in 55 patients. DGLA levels were significantly lower, and delta-5 desaturase activity was significantly higher in patients with delirium than in those without delirium (both < 0.001). Conversely, AA alone and omega-3 PUFAs did not differ between the groups. Additionally, DGLA and AA levels, but not omega-3 PUFA levels, were negatively associated; delta-5 desaturase activity was positively associated with the delirium score (both < 0.001). The duration of delirium was significantly associated with DGLA and AA levels ( = 0.001 and = 0.004, respectively). Moreover, multivariate analysis showed that decreased DGLA and increased delta-5 desaturase activity remained significant predictors of delirium. Low omega-6 PUFA levels and high delta-5 desaturase activity on admission were significantly associated with the development of delirium in the CICU, indicating that the evaluation of low omega-6 PUFA levels and related enzymes may identify patients at a high risk of developing delirium.
谵妄在入住重症监护病房的患者中很常见，且与死亡率和发病率相关。尽管多项研究报告了多不饱和脂肪酸（PUFAs）与认知障碍之间的关联，但急性心血管疾病患者中PUFA水平与谵妄发生之间的关联仍不清楚。本研究旨在阐明冠状动脉重症监护病房（CICU）中PUFA水平与谵妄发生之间的关联。我们纳入了顺天堂大学医院CICU连续收治的590例患者（平均年龄70±14岁）。在入院后24小时内测量空腹血清PUFA水平。Δ-5去饱和酶活性以花生四烯酸（AA）与二高-γ-亚麻酸（DGLA）的比值来估计。此外，谵妄被定义为使用重症监护谵妄筛查清单得分为≥4分的患者。55例患者出现了谵妄。与未发生谵妄的患者相比，发生谵妄的患者DGLA水平显著降低，Δ-5去饱和酶活性显著升高（均P＜0.001）。相反，两组间仅AA和ω-3 PUFAs无差异。此外，DGLA和AA水平呈负相关，但ω-3 PUFA水平并非如此；Δ-5去饱和酶活性与谵妄评分呈正相关（均P＜0.001）。谵妄持续时间与DGLA和AA水平显著相关（分别为P = 0.001和P = 0.004）。此外，多因素分析显示，DGLA降低和Δ-5去饱和酶活性升高仍然是谵妄的显著预测因素。入院时低ω-6 PUFA水平和高Δ-5去饱和酶活性与CICU中谵妄的发生显著相关，这表明评估低ω-6 PUFA水平及相关酶可能有助于识别发生谵妄风险较高的患者。
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