Preoperative Serum Metabolites Are Associated With Postoperative Delirium in Elderly Hip-Fracture Patients
Preoperative Serum Metabolites Are Associated With Postoperative Delirium in Elderly Hip-Fracture Patients
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DOI：
10.1093/gerona/glx001
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发表时间：
2017-12-01
影响因子：
5.1
通讯作者：
Jiang, Wei
中科院分区：
文献类型：
--
作者：
Guo, Yong;Zhang, Yinan;Jiang, Wei
背景：关于术后谵妄（PD）发生的假设包括“神经炎症”、“神经元衰老”、“氧化应激”、“神经递质缺乏”和“神经内分泌”。在这里，我们采用代谢组学来确定基线中与 PD 风险增加相关的血清代谢物。方法：选择了 209 名接受半髋关节置换术并完成我们评估的老年髋部骨折患者。手术当天早上7:00采集空腹静脉血，建立血清样本库进行分析。术后前 3 天，使用混乱评估方法（中文修订版）每天对患者进行两次评估。最终，43 名患者被诊断为 PD，构成 PD 组。同时，根据年龄、性别和体重指数选择了 43 名匹配的非 PD 患者。采用气相色谱-飞行时间质谱和Acquity超高效液相色谱-四极杆飞行时间质谱对两组血清样本进行分析。结果：两组的人口统计学特征相匹配。确定了四种与 PD 风险增加相关的代谢物，包括 S-甲基半胱氨酸、亚麻酸、二十碳五烯酸和亚油酸。 结论：PD 组的多种代谢途径在手术前发生了改变，包括 omega 3 和 omega 6 脂肪酸缺乏、能量代谢和氧化应激以及缺氧和线粒体功能障碍之间的相互作用，此外还有谷氨酸-谷氨酰胺循环功能障碍。这些代谢异常可能会增加大脑的脆弱性，进而导致帕金森病。
Background: Hypotheses on the development of postoperative delirium (PD) include "neuroinflammatory," "neuronal aging," " oxidative stress," "neurotransmitter deficiency," and "neuroendocrine." Here, we employed metabolomics to determine the serum metabolites in the baseline associated with an increased risk of PD.Methods: Two hundred and nine elderly hip-fracture patients who had undergone hemiarthroplasty and had completed our assessments were selected. Fasting venous blood was collected at 7:00 on the morning of surgery and a serum sample bank was created for analysis. On the first 3 postoperative days, the patients were assessed twice daily using the Confusion Assessment Method - Chinese Revision. Ultimately, 43 patients were diagnosed with PD, who comprised the PD group. Meanwhile, 43 matched non-PD patients were selected based on age, sex, and body mass index. Serum samples from the two groups were analyzed by gas chromatography-time-of-flight mass spectrometry and Acquity ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry.Results: The demographic characteristics of the groups were matched. Four metabolites associated with an increased risk of PD were identified, including S-methylcysteine, linolenic acid, eicosapentaenoic acid, and linoleic acid.Conclusions: Multiple metabolic pathways in the PD group altered before surgery, including deficiency of omega 3 and omega 6 fatty acids, energy metabolism and oxidative stress with interactions between hypoxia and mitochondrial dysfunction, in addition to glutamate-glutamine cycle dysfunction. These metabolic abnormalities could possibly increase the fragility of the brain and then contribute to PD.