ICU谵妄患者血清炎症因子水平的变化
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摘要
目的比较ICU谵妄患者与非谵妄患者炎症因子水平的差异。方法选择ICU停留时间>24 h的34例患者,采用重症监护病房患者意识模糊评估法(CAM-ICU)诊断谵妄,将患者分为谵妄组(17例)和非谵妄组(17例)。使用流式细胞蛋白分析技术(CBA)测定34例患者血浆中六类炎症因子水平——白细胞介素(interleukin,IL)-8、IL-6、IL-1β、IL-10、IL-12p70、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)。结果 IL-8、IL-6、IL-1β、IL-10、TNF-α在两组患者中结果比较差异均无统计学意义(P>0.05),IL-12p70水平在谵妄组明显高于非谵妄组(P<0.05)。IL-12p70预测ICU谵妄发生的受试者工作特征(ROC)曲线下面积(AUC)为0.728,以11.1 pg/mL为阈值,预测的敏感度为70.6%,特异度为76.5%。结论 ICU患者发生谵妄可能与炎症因子IL-12p70释放增加有关,早期检测IL-12P70水平可能有助于预测其风险。
Objective To compare the levels of inflammatory factors between patients with delirium and non-delirium in intensive care unit(ICU). Methods A total of 34 patients, who stayed in ICU more than 24 hours, were enrolled from February 2017 to February 2018. Patients were divided into delirium group(17 cases) and non-delirium group(17 cases). Delirium was assessed twice daily with the confusion assessment method-intensive care unit(CAM-ICU). The concentrations of inflammatory factors, including IL-8, IL-6, IL-1β, IL-10, TNF-α, IL-12 p70, were determined with cytometric bead array. Results There was no significant difference in IL-8, IL-6, IL-1β, IL-10 and TNF-α between the two groups(P>0.05). IL-12 p70 of delirium patients was significantly higher than the non-delirium patients(P<0.05). The area under ROC curve(AUC) for IL-12 p70 predicting delirium was 0.728, while the sensitivity and specificity of IL-12 p70 at threshold of 11.1 were 70.6% and 76.5%, respectively. Conclusion IL-12 p70 in ICU delirium patients is significantly increased. Early detection of IL-12 p70 can help to predict the risk of delirium for critically ill patients.
Objective To compare the levels of inflammatory factors between patients with delirium and non-delirium in intensive care unit(ICU). Methods A total of 34 patients, who stayed in ICU more than 24 hours, were enrolled from February 2017 to February 2018. Patients were divided into delirium group(17 cases) and non-delirium group(17 cases). Delirium was assessed twice daily with the confusion assessment method-intensive care unit(CAM-ICU). The concentrations of inflammatory factors, including IL-8, IL-6, IL-1β, IL-10, TNF-α, IL-12 p70, were determined with cytometric bead array. Results There was no significant difference in IL-8, IL-6, IL-1β, IL-10 and TNF-α between the two groups(P>0.05). IL-12 p70 of delirium patients was significantly higher than the non-delirium patients(P<0.05). The area under ROC curve(AUC) for IL-12 p70 predicting delirium was 0.728, while the sensitivity and specificity of IL-12 p70 at threshold of 11.1 were 70.6% and 76.5%, respectively. Conclusion IL-12 p70 in ICU delirium patients is significantly increased. Early detection of IL-12 p70 can help to predict the risk of delirium for critically ill patients.
引文
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[2] O′Mahony R,Murthy L,Akunne A,et al.Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium[J].Ann Intern Med,2011,154(11):746-751.
[3] Caplan JP,Rabinowitz T.An approach to the patient with cognitive impairment:delirium and dementia[J].Med Clin North Am,2010,94(6):1103-1116.
[4] 黄洁,肖倩,吴瑛,等.ICU谵妄危险因素的Meta分析[J].中华护理杂志,2010,45(1):6-9.
[5] Arumugam S,El-Menyar A,Al-Hassani A,et al.Delirium in the Intensive Care Unit[J].J Emerg Trauma Shock,2017,10(1):37-46.
[6] Agarwal V,O′Neill PJ,Cotton BA,et al.Prevalence and risk factors for development of delirium in burn intensive care unit patients[J].J Burn Care Res,2010,31(5):706-715.
[7] Shehabi Y,Riker RR,Bokesch PM,et al.Delirium duration and mortality in lightly sedated,mechanically ventilated intensive care patients[J].Crit Care Med,2010,38(12):2311-2318.
[8] Chen Y,Du H,Wei BH,et al.Development and validation of risk-stratification delirium prediction model for critically ill patients:A prospective,observational,single-center study[J].Medicine (Baltimore),2017,96(29):e7543.
[9] 杨娜瑜,姜丽华.老年患者术后谵妄的研究进展[J].临床麻醉学杂志,2013,29(10):1039-1040.
[10] Norden DM,Muccigrosso MM,Godbout JP.Microglial priming and enhanced reactivity to secondary insult in aging,and traumatic CNS injury,and neurodegenerative disease[J].Neuropharmacology,2015,96(Pt A):29-41.
[11] Tsuruta R,Oda Y.A clinical perspective of sepsis-associated delirium[J].J Intensive Care,2016,4:18.
[12] Maldonado JR.Neuropathogenesis of delirium:review of current etiologic theories and common pathways[J].Am J Geriatr Psychiatry,2013,21(12):1190-1222.
[13] Tracey KJ.Reflex control of immunity[J].Nat Rev Immunol,2009,9(6):418-428.
[14] Li Y,Liu L,Kang J,et al.Neuronal-glial interactions mediated by interleukin-1 enhance neuronal acetylcholinesterase activity and mRNA expression[J].J Neurosci,2000,20(1):149-155.
[15] Liu P,Li YW,Wang XS,et al.High serum interleukin-6 level is associated with increased risk of delirium in elderly patients after noncardiac surgery:a prospective cohort study[J].Chin Med J (Engl),2013,126(19):3621-3627.
[16] 文雯,迟猛,王国年.术后谵妄与神经递质[J].临床麻醉学杂志,2014,30(10):1037-1040.
[17] Hall RJ,Ferguson KJ,Andrews M,et al.Delirium and cerebrospinal fluid S100B in hip fracture patients:a preliminary study[J].Am J Geriatr Psychiatry,2013,21(12):1239-1243.
[18] Dantzer R,Konsman JP,Bluthe RM,et al.Neural and humoral pathways of communication from the immune system to the brain:parallel or convergent?[J].Auton Neurosci,2000,85(1/3):60-65.
[19] von Bernhardi R,Tichauer JE,Eugenin J.Aging-dependent changes of microglial cells and their relevance for neurodegenerative disorders[J].J Neurochem,2010,112(5):1099-1114.
[20] Dilger RN,Johnson RW.Aging,microglial cell priming,and the discordant central inflammatory response to signals from the peripheral immune system[J].J Leukoc Biol,2008,84(4):932-939.
[21] Kohman RA,Rhodes JS.Neurogenesis,inflammation and behavior[J].Brain Behav Immun,2013,27(1):22-32.
[22] 何艳,陈侣林,朱俊臣,等.右美托咪定对脓毒症患者谵妄的预防作用[J].实用药物与临床,2017,20(12):1376-1379.
[23] Pandharipande PP,Sanders RD,Girard TD,et al.Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis:an a priori-designed analysis of the MENDS randomized controlled trial[J].Crit Care,2010,14(2):R38.