阳虚质老年患者半髋关节置换术前血浆代谢物与术后谵妄相关性OA

Objective To preliminarily explore the correlation between Yang deficiency constitution(YDC)and postoperative delirium(POD)at the molecular level through metabolomics.Methods Fasting venous blood samples were collected from elderly patients undergoing hemiarthroplasty on the day of surgery.POD was dynamically assessed using the Confusion Assessment Method-Chinese Revision(CAM-CR)scale on postoperative days 1,3,and 5.Using POD as the outcome variable,univariate and multivariate Logistic regression analyses were performed to identify risk factors for POD.Based on preoperative Chinese Medicine(CM)constitution assessment,patients were assigned into a YDC group(n=52)and a non-YDC group(n=74)for untargeted metabolomic analysis to screen differential metabolites.Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis was conducted to preliminarily explore the potential mechanisms underlying POD in elderly YDC patients.Results Logistic regression analysis showed that age(OR=1.11,95％CI:1.04～1.18,P＜0.001),body mass index(BMI)(OR=1.03,95％CI:1.01～1.06,P=0.041),and YDC(OR=1.40,95％CI:1.01～1.55,P=0.033)were independent risk factors for POD.Untargeted metabolomics identified 41 preoperative plasma differential metabolites,including γ-aminobutyric acid(GABA),linoleic acid,and succinic acid.KEGG enrichment analysis revealed that these differential metabolites were significantly enriched in four key pathways:linoleic acid metabolism(P＜0.001),peroxisome proliferator-activated receptor(PPAR)signaling pathway(P=0.001),cyclic adenosine monophosphate(cAMP)signaling pathway(P=0.003),and GABA ergic synapse(P=0.005).Conclusions YDC is an independent risk factor for POD.The potential mechanisms of POD in elderly YDC patients are related to imbalances in linoleic acid metabolism,abnormalities in PPAR/cAMP signaling,and disturbances in GABA ergic synaptic function.These findings provide a new direction for perioperative neuroprotective strategies based on CM constitution theory.