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

Abstract

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

CLC Number:

R 749.25

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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T cell mitochondrial dysfunction link to postoperative delirium in elderly thoracic surgery patients

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