Time-course of cytokines during delirium in elderly patients with hip fractures
Time-course of cytokines during delirium in elderly patients with hip fractures
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DOI：
10.1111/j.1532-5415.2008.01851.x
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发表时间：
2008-09-01
影响因子：
6.3
通讯作者：
De Rooij, Sophia E.
中科院分区：
文献类型：
--
作者：
van Munster, Barbara C.;Korevaar, Johanna C.;De Rooij, Sophia E.
目的：比较谵妄患者和非谵妄患者细胞因子水平的时间进程，并研究谵妄亚型细胞因子浓度的差异。设计：前瞻性队列研究。地点：阿姆斯特丹学术医学中心，2005年至2007年。参与者：65岁及以上髋部骨折后接受手术的患者。测量：经验丰富的老年内科医生使用意识模糊评估方法评估谵妄和谵妄症状访谈评估谵妄亚型。肿瘤坏死因子-α（TNF-α）和白细胞介素（IL）-1 β，IL-6，IL-8，IL-10和IL-12进行了测定，在重复的血清样本使用流式细胞仪珠阵列immunoassay.RESULTS：在221入院患者，98（平均年龄84岁，50例谵妄），共324个样本。这些样本中有96%的TNF-α，IL-1 β和IL-10水平低于可靠的检测水平。观察到伴有和不伴有谵妄的患者在IL-6（中位数51 vs 36 pg/mL，P= 0.01）和IL-8（中位数15 vs 9 pg/mL，P= 0.03）水平上存在差异。谵妄患者IL-6和IL-8水平随时间的变化与无谵妄患者的水平变化显著不同。最高水平的IL-6出现在谵妄期间，最高水平的IL-8出现在谵妄发展之前。多动型（中位数71 pg/mL）或混合型（中位数73 pg/mL）谵妄患者的IL-6水平高于低动型谵妄患者（中位数16 pg/mL）（P= 0.02）。结论：IL-6和IL-8可能参与了老年人术后谵妄的发病机制。IL-6可能在谵妄的多动行为中起作用。
OBJECTIVES: To compare the time-course of cytokine levels in patients with and without delirium and investigate differences in cytokine concentrations in delirium subtypes.DESIGN: Prospective cohort study.SETTING: Academic Medical Center, Amsterdam, 2005 through 2007.PARTICIPANTS: Patients aged 65 and older admitted for surgery after hip fracture.MEASUREMENTS: Experienced geriatric physicians used the Confusion Assessment Method to assess delirium and the Delirium Symptom Interview to assess delirium subtype. Tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-1 beta, IL-6, IL-8, IL-10, and IL-12 were assayed in repeated serum samples using a cytometric bead array immunoassay.RESULTS: Of 221 admitted patients, 98 (mean age 84, 50 patients with delirium) were included, resulting in a total of 324 samples. Ninety-six percent of these samples had TNF-alpha, IL-1 beta, and IL-10 levels below the reliable detection level. Differences between patients with and without delirium were observed in IL-6 (median 51 vs 36 pg/mL, P=.01) and IL-8 (median 15 vs 9 pg/mL, P=.03) levels. Changes over time in IL-6 and IL-8 levels in patients with delirium differed significantly from changes in levels in patients without delirium. The highest levels of IL-6 were present during delirium, and the highest levels of IL-8 were present before the development of delirium. Patients with the hyperactive (median 71 pg/mL) or mixed (median 73 pg/mL) subtype of delirium had higher IL-6 levels than patients with hypoactive delirium (median 16 pg/mL) (P=.02).CONCLUSION: IL-6 and IL-8 may contribute to the pathogenesis of postoperative delirium in elderly people. IL-6 may play a role in the hyperactive behavior of delirium.