Plasma insulin growth factor-1 and incident delirium in older people
Plasma insulin growth factor-1 and incident delirium in older people
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DOI：
10.1002/gps.1265
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发表时间：
2005-02-01
影响因子：
4
通讯作者：
Mottram, P
中科院分区：
文献类型：
--
作者：
Wilson, K;Broadhurst, C;Mottram, P
各种人口统计学和临床变量被认为是谵妄的危险因素；一种被认为是由大量神经递质异常引起的综合征。然而，这方面的研究很少，神经免疫因子作为一种药物机制的作用也很少受到关注。目的确定低基线（入院时）IGF-1水平（脑细胞对侮辱反应释放的一种保护性细胞因子）是否是75岁及以上急症病房住院患者发生谵妄的危险因素。方法连续测定100例非谵妄住院患者的基线人口学、临床变量及血清IGF-1水平。在住院期间，每天评估受试者谵妄的发展情况。结果12例患者出现偶发性谵妄。IGF-1 （OR: 0.822, CI: 0.69, 0.97,p = 0.027）、入院前认知恶化（由IQCODE评估）（OR; 3.26, CI: 1.18, 9.04, p = 0.023）和抑郁（GDS四项：临界值大于等于3）（OR; 8.99, CI 1.59,50.76, p = 0.013）被确定为发生继发性谵妄的危险因素。尽管这项研究的规模很小，但我们的研究结果表明，发病前的低IGF-1是该人群随后谵妄的一个危险因素，强调了这种合成代谢细胞因子的潜在保护作用，以及需要复制这些发现。版权所有(C) 2005约翰威利股份有限公司
Background A variety of demographic and clinical variables are acknowledged as risk factors for delirium; a syndrome thought to be mediated by abnormalities in a wide range of neurotransmitters. However, little research has been conducted in this field and the role of neuro-immunological factors as a mechanism of medication has received very little attention.Aims To determine if low baseline (on admission) IGF-1 levels (a protective cytokine released by brain cells in response to insult) is a risk factor for incident delirium in patients aged 75 and over admitted to an acute medical ward.Method Base line demographic and clinical variables and serum IGF-1 levels were measured in a consecutive series of 100 non-delirious subjects on inpatient admission. Subjects were assessed daily regarding the development of delirium during the inpatient episode.Results Twelve patients developed incident delirium. IGF-1 (OR: 0.822, CI: 0.69, 0.97,p = 0.027), pre-admission cognitive deterioration (assessed by IQCODE) (OR; 3.26, CI: 1.18, 9.04, p = 0.023) and depression (GDS four item: cut-off score greater than or equal to 3) (OR; 8.99, CI 1.59,50.76, p = 0.013) were identified as risk factors for developing subsequent delirium.Conclusions Despite the small size of this study our findings suggest that low, pre-morbid IGF-1 is a risk factor for subsequent delirium in this population, emphasizing the potential protective role of this anabolic cytokine and the need for replication of these findings. Copyright (C) 2005 John Wiley Sons, Ltd.