T细胞线粒体功能障碍与老年胸科手术患者术后谵妄的相关性

doi:10.3969/j.issn.1003-9198.2026.04.011

摘要/Abstract

摘要： 目的探讨老年胸科手术患者术前T细胞线粒体功能障碍与术后谵妄(postoperative delirium,POD)的关系。方法选取2024年1—11月南京医科大学第二附属医院收治的择期全身麻醉下行胸科手术的133例老年患者为研究对象,于术前采集患者静脉血进行T细胞耗竭和线粒体功能障碍相关指标检测,术后1~3 d使用中文版3 min谵妄诊断量表(3-minutes delirium diagnostic scale,3D-CAM)评估患者POD发生情况。根据术后3 d内是否发生POD将患者分为谵妄组(POD组)和非谵妄组(NPOD组)。采用多因素logistic回归模型分析T细胞耗竭和线粒体功能障碍与POD的关系。结果 133例患者中有31例发生POD。POD组年龄、术后住院时长、住院总时长、术前中性粒细胞百分比、中性粒细胞数目、白细胞数目、C反应蛋白水平明显高于NPOD组,BMI、术前淋巴细胞百分比、白蛋白明显低于NPOD组,差异有统计学意义(P<0.05)。在T细胞耗竭和线粒体功能障碍检测中,与NPOD组相比,POD组CD3⁺CD4⁺PD-1⁺T细胞百分比明显增高,CD45⁺淋巴细胞百分比、CD3⁺MMP-Low T细胞百分比、CD3⁺CD4⁺MMP-Low T细胞百分比及CD3⁺CD8⁺MMP-Low T细胞百分比明显降低,差异有统计学意义(P<0.05)。在调整混杂因素后,年龄(OR=1.110,95%CI:1.004~1.229)是POD的独立危险因素,术前CD3⁺CD4⁺MMP-Low T细胞百分比(OR=0.762,95%CI:0.608~0.956)、CD3⁺CD8⁺MMP-Low T细胞百分比(OR=0.857,95%CI:0.737~0.997)和BMI(OR=0.818,95%CI:0.672~0.996)是POD的独立保护因素。结论在接受胸科手术的老年患者中,年龄、BMI、CD3⁺CD4⁺MMP-Low T细胞百分比和CD3⁺CD8⁺MMP-Low T细胞百分比是POD的独立影响因素。

关键词: 免疫衰老, T细胞耗竭, 线粒体功能障碍, 胸科手术, 术后谵妄, 老年人

Abstract: Objective To investigate the relationship between preoperative T cell mitochondrial dysfunction and postoperative delirium (POD) in elderly patients undergoing thoracic surgery. Methods A total of 133 elderly patients scheduled for elective thoracic surgery under general anesthesia at the Second Affiliated Hospital of Nanjing Medical University from January to November 2024 were enrolled. Preoperative venous blood samples were collected for T cell exhaustion and mitochondrial dysfunction assessment. Postoperative delirium (POD) was evaluated within 1-3 days after surgery using the 3-Minutes Delirium Diagnostic Scale (3D-CAM). Patients were divided into POD group and non-POD (NPOD) group based on POD occurrence within 3 days. Multivariable logistic regression was employed to analyze the relationship between T cell exhaustion, mitochondrial dysfunction, and POD. Results Among 133 patients, 31 patients developed POD. Compared with the NPOD group, the patients in the POD group had significantly higher age, postoperative hospital stay duration, total hospital stay duration, preoperative neutrophil percentage, neutrophil count, white blood cell count, and C-reactive protein, while body mass index(BMI), preoperative lymphocyte percentage, and albumin were significantly lower in the POD group (P<0.05). Regarding T cell and mitochondrial dysfunction, patients in the POD group showed significantly increased levels of percentage of CD3⁺CD4⁺PD-1⁺ T cells and decreased levels of percentage of CD45⁺ lymphocytes, percentage of CD3⁺MMP-Low T cells, percentage of CD3⁺CD4⁺MMP-Low T cells and percentage of CD3⁺CD8⁺MMP-Low T cells (P<0.05). After adjusting for confounding factors, age was identified as an independent risk factor for POD (OR=1.110, 95%CI:1.004-1.229), whereas CD3⁺CD4⁺MMP-Low T cell percentage(OR=0.762,95%CI: 0.608-0.956), CD3⁺CD8⁺MMP-Low T cell percentage (OR=0.857,95%CI: 0.737-0.997)and BMI(OR=0.818,95%CI: 0.672-0.996)served as independent protective factors. Conclusions Among elderly patients undergoing thoracic surgery, age, BMI, preoperative percentage of CD3⁺CD4⁺MMP-low T cells, and percentage of CD3⁺CD8⁺MMP-low T cells were identified as independent factors associated with POD.

Key words: immunosenescence, T cell exhaustion, mitochondrial dysfunction, thoracic surgery, postoperative delirium, aged

中图分类号:

R 749.25

柳雯, 刘昱廷, 纪木火. T细胞线粒体功能障碍与老年胸科手术患者术后谵妄的相关性[J]. 实用老年医学, 2026, 40(4): 382-388.

LIU Wen, LIU Yuting, JI Muhuo. T cell mitochondrial dysfunction link to postoperative delirium in elderly thoracic surgery patients[J]. Practical Geriatrics, 2026, 40(4): 382-388.

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