Chemokines are associated with delirium after cardiac surgery
Chemokines are associated with delirium after cardiac surgery
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DOI：
10.1093/gerona/63.2.184
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发表时间：
2008-02-01
影响因子：
5.1
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Rudolph, James L.;Ramlawi, Basel;Marcantonio, Edward R.
背景谵妄被假设为在血脑屏障受损状态下对全身炎症的中枢神经系统反应。本研究的目的是比较心脏手术后发生谵妄的患者和对照组无谵妄患者术后炎症标志物的变化。从42名接受心脏手术的患者术前和术后6小时和术后第4天采集血清样本。采用微球流式细胞仪测定28种炎症标志物的血清浓度。先验，炎症标志物被分配到五类细胞因子。通过平均每个类别中标志物的标准化、归一化水平来计算7级评分。从术后第2天开始，患者每天进行谵妄评估。12例谵妄患者在手术时间、年龄和基线认知方面与12例无谵妄患者相匹配。在6小时的时间点，与匹配的对照组相比，继续发展谵妄的患者具有更高的趋化因子增加（z类评分0.3 +/-1.0，p <0.05）。在5类细胞因子中，在术后6小时或术后第4天评估时，有或无谵妄患者之间无其他显著差异。心脏手术后，在术后早期出现谵妄的患者中趋化因子水平升高。由于趋化因子在体外能够破坏血脑屏障的完整性，未来的研究需要确定这些炎症介质与谵妄发病机制的关系。
Background. Delirium has been hypothesized to be a central nervous system response to systemic inflammation during a state of blood-brain barrier compromise. The purpose of this study was to compare postoperative changes in groups of inflammatory markers in persons who developed delirium following cardiac surgery and matched controls without delirium.Methods. Serum samples were drawn from 42 patients undergoing cardiac surgery preoperatively and postoperatively at 6 hours and postoperative day 4. The serum concentrations of 28 inflammatory markers were determined with a microsphere flow cytometer. A priori, inflammatory markers were assigned to five classes of cytokines. A class 7 score was calculated by averaging the standardized, normalized levels of the markers in each class. Beginning on postoperative day 2, patients underwent a daily delirium assessment.Results. Twelve patients with delirium were matched by surgical duration, age, and baseline cognition to 12 patients without delirium. At the 6-hour time point, patients who went on to develop delirium had higher increases of chemokines compared to matched controls (class z score 0.3 +/- 1.0, p < .05). Among the five classes of cytokines, there were no other significant differences between patients with or without delirium at either the 6 hour or postoperative day 4 assessments.Conclusion. After cardiac surgery, chemokine levels were elevated in patients who developed delirium in the early postoperative period. Because chemokines are capable of disrupting blood-brain barrier integrity in vitro, future studies are needed to define the relationship of these inflammatory mediators to delirium pathogenesis.