The Stress Response to Surgery and Postoperative Delirium: Evidence of Hypothalamic-Pituitary-Adrenal Axis Hyperresponsiveness and Decreased Suppression of the GH/IGF-1 Axis
The Stress Response to Surgery and Postoperative Delirium: Evidence of Hypothalamic-Pituitary-Adrenal Axis Hyperresponsiveness and Decreased Suppression of the GH/IGF-1 Axis
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DOI：
10.1177/0891988713495449
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发表时间：
2013-09-01
影响因子：
2.6
通讯作者：
Mukaetova-Ladinska, Elizabeta B.
中科院分区：
文献类型：
--
作者：
Cerejeira, Joaquim;Batista, Pedro;Mukaetova-Ladinska, Elizabeta B.
简介：本研究的目的是确定术后谵妄是否与急性全身炎症后下丘脑-垂体-肾上腺和生长激素/胰岛素样生长因子 1 (GH/IGF-1) 反应失调相关。方法：测量 60 年来 101 名患者手术前后的血浆皮质醇、IGF-1、C 反应蛋白、白细胞介素 (IL)-6、IL-8 和 IL-10 水平没有痴呆症，接受选择性髋关节置换术。术后采用精神障碍诊断与统计手册（第四版，文本修订版；DSM-IV-TR）对参与者进行评估，37例患者满足DSM-IV-TR谵妄标准。结果：谵妄组和非谵妄组术前血浆皮质醇水平相似（405.37+/-189.04 vs 461.83+/-219.39；P = .22)。患有谵妄的参与者术后皮质醇水平较高（821.67 +/- 367.17 vs 599.58 +/- 214.94；P = .002），术后皮质醇水平较基线升高（1.9 倍 vs 1.5 倍；P = .004）。谵妄组和非谵妄组在手术前（18.12 +/- 7.58 vs 16.8 +/- 7.86；P = .477）和手术后（13.39 +/- 5.94 vs 11.12 +/- 6.2；P = .639）血浆 IGF1 水平没有差异，但在发生谵妄的患者中，IGF1 水平较基线升高的频率更高（24.3% 与 7.8%；P = .034）。仅在谵妄患者中，术后皮质醇升高的程度与 IL-6 (P = .485; P = .002)、IL-8 (P = .429; P = .008) 和 IL-10 (P = .544; P < .001) 相关。 结论：下丘脑-垂体-肾上腺轴高反应性和较少频率的抑制响应急性应激的 GH/IGF-1 轴可能参与谵妄的病理生理学。
Introduction:The aim of this study is to determine whether postoperative delirium is associated with dysregulation of hypothalamic-pituitary-adrenal and growth hormone/insulin-like growth factor 1 (GH/IGF-1) responses following acute systemic inflammation.Methods:Plasma levels of cortisol, IGF-1, C-reactive protein, interleukin (IL)-6, IL-8, and IL-10 were measured before and after surgery in 101 patients 60 years without dementia undergoing elective hip arthroplasty. Participants were assessed with confusion assessment method and Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) postoperatively and 37 patients fulfilled the DSM-IV-TR criteria for delirium.Results:Preoperative plasma cortisol levels were similar in delirium and nondelirium groups (405.37 +/- 189.04 vs 461.83 +/- 219.39; P = .22). Participants with delirium had higher postoperative cortisol levels (821.67 +/- 367.17 vs 599.58 +/- 214.94; P = .002) with enhanced postoperative elevation in relation to baseline (1.9- vs 1.5-fold; P = .004). The plasma levels of IGF1 did not differ in delirium and nondelirium groups before (18.12 +/- 7.58 vs 16.8 +/- 7.86; P = .477) and following surgery (13.39 +/- 5.94 vs 11.12 +/- 6.2; P = .639), but the levels increased in relation to baseline more frequently in patients who developed delirium (24.3% vs 7.8%; P = .034). The magnitude of postoperative cortisol elevation correlated with IL-6 (P = .485; P = .002), IL-8 (P = .429; P = .008), and IL-10 (P = .544; P < .001) only in patients with delirium.Conclusions:Hypothalamic-pituitary-adrenal axis hyperresponsiveness and a less frequent suppression of the GH/IGF-1 axis in response to acute stress are possibly involved in delirium pathophysiology.