■具有体外循环(CPB)的心脏手术被认为是术后谵妄(POD)发生率最高的手术类型之一。POD与长期的重症监护和住院时间有关,长期的神经认知恶化,和死亡率增加。然而,POD的具体发病机制尚不清楚。非靶向代谢组学技术可用于了解POD早期血清代谢产物的变化,从而发现血清代谢产物与疾病的关系。
■本研究招募了58例接受CPB心脏手术的老年患者。在手术后的第一个24小时内收集血清。使用混淆评估方法(CAM)和ICU-CAM评估来识别发生POD的患者。所有术后认知评估正常的患者均纳入非POD组。此外,我们收集了20名健康成人志愿者的血清。我们对所有手术组的术后血清代谢物进行了无针对性分析,以及健康非手术成人的血清代谢产物,采用液相色谱质谱(LC/MS)分析代谢谱和相关代谢产物。
■心脏手术后发生POD的概率为31%。术后机械通气时间差异有统计学意义,POD组和非POD组患者ICU停留时间和术后住院时间比较差异有统计学意义(P<0.05)。ICU停留时间是POD的独立危险因素。分析显示,通过比较POD和非POD组共鉴定出51种差异表达代谢物(DEM),主要是脂质和类脂分子。POD组3种磷脂酰肌醇(PI)表达下调,即,PI[18:0/18:2(9Z,12Z)],PI[20:4(8Z,11Z,14Z,17Z)/18:0],和PI[18:1(9Z)/20:3(8Z,11Z,14Z)].受试者工作特征(ROC)曲线分析表明,三种PI代谢物的曲线下面积(AUC)最高,分别为0.789、0.781和0.715。相关性分析显示3种PIs的表达与POD的发生呈负相关。
■我们的发现表明,脂质代谢在老年POD患者术后早期的血清代谢谱中起重要作用。低脂代谢PI与老年人心脏搭桥手术后POD发生率相关,这可能为POD的发病机制提供新的见解。
UNASSIGNED: Cardiac surgery with cardiopulmonary bypass (CPB) is considered to be one of the surgical types with the highest incidence of post-operative delirium (POD). POD has been associated with a prolonged intensive care and hospital stay, long-term neurocognitive deterioration, and increased mortality. However, the specific pathogenesis of POD is still unclear. Untargeted metabolomics techniques can be used to understand the changes of serum metabolites in early POD to discover the relationship between serum metabolites and disease.
UNASSIGNED: The present study recruited 58 elderly patients undergoing cardiac surgery with CPB. Serum was collected within the first 24 h after surgery. The Confusion Assessment Method (CAM) and ICU-CAM assessments were used to identify patients who experienced POD. All patients with normal post-operative cognitive assessment were included in the non-POD groups. Moreover, we collected serum from 20 healthy adult volunteers. We performed untargeted analyses of post-operative serum metabolites in all surgical groups, as well as serum metabolites in healthy non-surgical adults by using liquid chromatography mass spectrometry (LC/MS) and analyzed metabolic profiles and related metabolites.
UNASSIGNED: The probability of POD after cardiac surgery were 31%. There were statistically significant differences in post-operative mechanical ventilation time, ICU stay time and post-operative hospital stay between POD and non-POD group (P < 0.05). And ICU stay time was an independent risk factor for POD. The analysis revealed that a total of 51 differentially expressed metabolites (DEMs) were identified by comparing the POD and non-POD group, mostly lipids and lipid-like molecules. Three
phosphatidylinositol (PI) were down-regulated in POD group, i.e., PI [18:0/18:2 (9Z, 12Z)], PI [20:4 (8Z, 11Z, 14Z, 17Z)/18:0], and PI [18:1 (9Z)/20:3 (8Z, 11Z, 14Z)]. The receiver operating characteristic (ROC) curve analysis showed that three kinds of PI metabolites had the highest area under the curve (AUC), which were 0.789, 0.781, and 0.715, respectively. Correlation analysis showed that the expression of three PIs was negatively correlated with the incidence of POD.
UNASSIGNED: Our findings suggest that lipid metabolism plays an important role in the serum metabolic profile of elderly patients with POD in the early post-operative period. Low serum lipid metabolic PI was associated with incidence of POD in elderly following cardiac bypass surgery, which may provide new insights into the pathogenesis of POD.