成人谵妄相关生物标志物及其临床应用价值

doi:10.13865/j.cnki.cjbmb.2020.09.1197

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摘要谵妄是一种多因素多途径引起的临床综合征，主要表现为意识、注意力、认知与感知改变。成年病人中谵妄发生率高，且可导致院内病死率增加、术后并发症发生率增加、住院时间延长、再入院率增加、医疗费用增加等多种不良结局，严重影响病人愈后。谵妄生物标志物研究与临床应用对早期预防、诊断及干预的实施和效果评价有重要意义。国外已有较多研究探讨成人领域多种生物标志物与谵妄发生率及严重程度的相关性。然而，国内该方面研究较少。故本文就成人谵妄生物标志物的研究展开综述，总结了包括谵妄的神经内分泌标志物、神经递质类标志物、炎性反应标志物、个体易感性标志物及神经损伤标志物在内的十余种成人谵妄生物标志物的来源、性质及其临床应用价值。研究发现，成人谵妄相关生物标志物种类繁多，然而包括5-羟色胺及相关氨基酸等在内的部分标志物与谵妄的相关性，各研究结论尚不一致；中性粒细胞/淋巴细胞比值等白细胞指标有良好的临床应用前景，但由于目前相关研究较少，其与谵妄的相关性亟待更多大样本研究加以明确；而C反应蛋白、褪黑素及S-100β水平则可作为成人谵妄的敏感生物标志物。本文一方面为谵妄生物标志物的临床应用提供一定的理论依据，另一方面也为谵妄生物标志物的进一步研究探索提供新思路。

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	郑清如
	卫婉蕊
	戈晓华

关键词 ：成人, 谵妄, 生物标志物, 临床应用, 病理生理

Abstract：

Delirium is a clinical syndrome caused by a variety of factors, mainly manifested as changes in consciousness, attention, cognition and perception. The incidence of delirium is high, and it leads to many adverse outcomes, such as increased in-hospital mortality, increased incidence of postoperative complications, prolonged hospital stay, increased cost and re-admission rates, all of which seriously affect the prognosis of patients. The research and clinical application of the biomarkers of delirium are critically meaningful for the early prevention, diagnosis and intervention of delirium. There have been many studies abroad to explore the correlation between multiple biomarkers and adult delirium, but there are few studies on related aspects in China. This paper reviews the research on the biomarkers of adult delirium, summarizes the sources, properties and clinical application values of more than ten biomarkers of adult delirium, including neuroendocrine markers, neurotransmitter markers, inflammatory reaction markers, markers of individual susceptibility and nerve injury markers. It has been found that there are many kinds of biomarkers. However, the correlation of some biomarkers is not consistent, such as serotonin and related amino acids. The neutrophil-to-lymphocyte ratio and other leukocyte indicators have good clinical application prospects. However, due to the lack of relevant studies, the correlation between them and delirium still warrants further investigation. The C-reactive protein, melatonin and S-100 β levels can be used as sensitive biomarkers of adult delirium. We hope that this paper will provide a theoretical basis for the clinical application of delirium biomarkers, and also provide new ideas for the further research and exploration of delirium biomarkers.

Key words： adult delirium biomarkers clinical application pathophysiology

收稿日期: 2020-04-24 出版日期: 2020-11-25

PACS:

R446

基金资助:上海市教委交大护理高原学科基金项目（No.Hlgy1804dxk）资助

通讯作者: 戈晓华 E-mail: gexiaohua@shsmu.edu.cn

引用本文:

郑清如,卫婉蕊,戈晓华. 成人谵妄相关生物标志物及其临床应用价值[J]. 中国生物化学与分子生物学报, 2020, 36(11): 1288-1294.
ZHENG Qing-Ru, WEI Wan-Rui, GE Xiao-Hua. Biomarkers for Adult Delirium and Their Clinical Applications. Chinese Journal of Biochemistry and Molecular Biol, 2020, 36(11): 1288-1294.

链接本文:

http://cjbmb.bjmu.edu.cn/CN/10.13865/j.cnki.cjbmb.2020.09.1197 或 http://cjbmb.bjmu.edu.cn/CN/Y2020/V36/I11/1288

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