术前IL-17A与术后谵妄在老年髋关节手术患者中的关系：一项针对糖尿病亚组的探索性分析

Relationship between Preoperative IL-17A and Postoperative Delirium in Elderly Patients Undergoing Hip Surgery: An Exploratory Analysis for a Subgroup with Diabetes Mellitus

摘要: 目的：术后谵妄是老年患者术后常见的一种并发症，其发病机制以及生物标志物仍未完全明确，近年来被发现与神经炎症反应密切相关。白介素-17A (IL-17A)作为一种促炎症细胞因子，并且在高浓度的血糖环境下可以通过激活Th17细胞并促进其释放，但是其术前水平与术后谵妄的关系尚不明确。本研究旨在探讨老年髋关节手术患者术前IL-17A浓度与术后谵妄的关系，并探索性分析糖尿病人群中IL-17A浓度与术后谵妄的关系。方法：本研究为前瞻性队列研究，纳入2023年1月至2023年12月期间251名接受过髋关节手术的患者(65岁及以上)，最终有203人符合条件并纳入分析。术前血浆IL-17A浓度通过ElISA方法进行检测，在术后1~7天通过意识模糊评估量表(CAM)评估患者谵妄发生的情况，主要结局是通过多因素Logistic分析术前IL-17A血浆浓度与术后谵妄的关系，次要结局是分析糖尿病患者与非糖尿病患者IL-17A血浆浓度的差异以及糖尿病病人中IL-17A血浆浓度与术后谵妄的关系。结果：在203名患者中23人(11.33%)发生了术后谵妄。低BMI、高龄、失血量、以及糖尿病是患者术后谵妄的独立危险因素。整体人群中，术前IL-17A浓度在谵妄组与非谵妄组无明显差异。然而，糖尿病亚组中IL-17A水平呈升高趋势，但受限于样本量(n = 43)，该发现仅为假设生成性质。结论：低BMI，高龄，失血量，以及糖尿病是患者术后谵妄的独立危险因素，糖尿病患者术前IL-17A的浓度显著增高，且与术后谵妄发生相关，提示IL-17A可能作为老年糖尿病患者术后谵妄的潜在生物学标志物。

Abstract: Objective: Postoperative delirium is a common postoperative complication in elderly patients, and its pathogenesis as well as biomarkers are still not fully clarified. Interleukin-17A (IL-17A), as a pro-inflammatory cytokine, has been closely associated with neuroinflammatory responses in recent years and can be activated by the activation of Th17 cells and promote its release in the presence of high blood glucose concentrations. However, the relationship between its preoperative levels and postoperative delirium is still unclear. This study investigates the association between preoperative IL-17A concentration and postoperative delirium in elderly hip surgery patients, and conducts an exploratory analysis of the relationship between IL-17A concentration and postoperative delirium in the diabetic population. Methods: This study was a prospective cohort study, including 251 patients (aged 65 years and above) who underwent hip surgery between January 2023 and December 2023. A total of 203 patients met the criteria and were included in the analysis. Preoperative plasma IL-17A concentration was measured using enzyme-linked immunosorbent assay (ELISA). Postoperative delirium was assessed using the Confusion Assessment Method (CAM) from postoperative days 1 to 7. The relationship between preoperative IL-17A plasma concentration and postoperative delirium was analyzed using multivariate logistic regression, The next step was to analyze the differences in IL-17A plasma concentrations between diabetic and non-diabetic patients. Results: Among the 203 patients, 23 (11.33%) developed postoperative delirium. Low BMI, advanced age, blood loss, and diabetes mellitus were identified as independent risk factors for postoperative delirium. There was no significant difference in preoperative IL-17A concentration in the overall population between the delirium and non-delirium groups. However, In the diabetic subgroup, IL-17A levels exhibited an increasing trend; however, given the limited sample size (n = 43), this finding should be regarded as hypothesis-generating. Conclusion: Low BMI, advanced age, blood loss, and diabetes mellitus are independent risk factors for postoperative delirium. In diabetic patients, elevated preoperative IL-17A concentration is significantly associated with the occurrence of postoperative delirium, suggesting that IL-17A may serve as a potential biomarker for postoperative delirium in elderly diabetic patients.