Cerebrospinal fluid cortisol levels are higher in patients with delirium versus controls.
Cerebrospinal fluid cortisol levels are higher in patients with delirium versus controls.
复制标题
DOI：
10.1186/1756-0500-3-33
复制
发表时间：
2010-02-08
影响因子：
1.8
通讯作者：
MacLullich AM
中科院分区：
文献类型：
--
作者：
Pearson A;de Vries A;Middleton SD;Gillies F;White TO;Armstrong IR;Andrew R;Seckl JR;MacLullich AM
血浆皮质醇水平高可导致急性认知和神经精神功能障碍，并与精神错乱有关。脑脊液皮质醇水平更能反映大脑对皮质醇的暴露，但目前还没有关于精神错乱患者脑脊液皮质醇水平的研究。在这项先导性研究中，我们采集了接受髋部骨折手术的患者在脊麻开始时的脑脊液样本，并比较了妄想症患者和对照组的脑脊液和血浆皮质醇水平。在手术的前一晚或第二天早上用标准的成套测验进行精神错乱的评估，包括认知测试、精神状态评估和迷惑评估方法。在手术开始时采集脑脊液和血浆样本，并测量皮质醇水平。20例患者，女性15例，男性5例，年龄62~93岁。7名患者被诊断为精神错乱。病例组的平均年龄(81.4岁，SD 7.2)与对照组的平均年龄(80.5岁，SD 8.7)无显著差异(p=0.88)。脑脊液皮质醇水平的中位数(四分位数范围)病例组(63.9nmol/L)显著高于对照组(31.4nmoL/L；Mann-Whitney U，p=0.029)。病例组血浆皮质醇的中位数(四分位数范围)(968.8(886.2-1394.4)nmol/L)也显著高于对照组(809.4(544.0-986.4)nmol/L；Mann Whitney U，p=0.036)。这些发现支持较高的脑脊液皮质醇水平与精神错乱之间的联系。这是对先前发现血浆皮质醇升高与精神错乱之间联系的扩展，并表明现在需要对皮质醇水平和精神错乱之间的关系进行更明确的研究。
High plasma cortisol levels can cause acute cognitive and neuropsychiatric dysfunction, and have been linked with delirium. CSF cortisol levels more closely reflect brain exposure to cortisol, but there are no studies of CSF cortisol levels in delirium. In this pilot study we acquired CSF specimens at the onset of spinal anaesthesia in patients undergoing hip fracture surgery, and compared CSF and plasma cortisol levels in delirium cases versus controls. Delirium assessments were performed the evening before or on the morning of operation with a standard battery comprising cognitive tests, mental status assessments and the Confusion Assessment Method. CSF and plasma samples were obtained at the onset of the operation and cortisol levels measured. Twenty patients (15 female, 5 male) aged 62 - 93 years were studied. Seven patients were diagnosed with delirium. The mean ages of cases (81.4 (SD 7.2)) and controls (80.5 (SD 8.7)) were not significantly different (p = 0.88). The median (interquartile range) CSF cortisol levels were significantly higher in cases (63.9 (40.4-102.1) nmol/L) than controls (31.4 (21.7-43.3) nmol/L; Mann-Whitney U, p = 0.029). The median (interquartile range) of plasma cortisol was also significantly higher in cases (968.8 (886.2-1394.4) nmol/L, than controls (809.4 (544.0-986.4) nmol/L; Mann Whitney U, p = 0.036). These findings support an association between higher CSF cortisol levels and delirium. This extends previous findings linking higher plasma cortisol and delirium, and suggests that more definitive studies of the relationship between cortisol levels and delirium are now required.