载脂蛋白E基因多态性与术后谵妄的关系

Association of apolipoprotein E gene polymorphism with postoperative delirium

目的探讨载脂蛋白E（ApoE）基因多态性与老年非心脏手术患者术后谵妄是否具有相关性。方法212例65岁以上的择期非心脏手术患者纳入研究,于手术后13 d密切随访,根据CAM的标准判断患者有无发生谵妄。用突变特异性多重扩增系统（multi-ARMS PCR）方法测定患者ApoE基因型。结果212例患者中有45例发生术后谵妄,共检出ApoEε4等位基因携带者18例（8.5%）。谵妄组有3例ApoEε4携带者（6.7%）,非谵妄组有15例ApoEε4携带者（9.0%）,两组比较无显著差异。ε4/4纯合子型共有4例,其中1例术前3 d发生过一过性谵妄,还有1例发生术后严重谵妄,症状持续17 d。结论ApoEε4等位基因与术后谵妄发病率无显著的相关性,但ε4/4纯合子型可能更容易发生谵妄。

Objective To investigate whether apolipoprotein E（ApoE） genotypes is associated with postoperative delirium in aged noncardiac surgical patients.Methods Two hundreds and twelve inpatients over 65y,undergoing selective noncardiac surgeries were enrolled in the study.The patients were frequently interviewed and evaluated prospectively for delirium with the Confusion Assessment Method（CAM） during the first three postoperative days.ApoE genotype was determined using multiplex amplification refractory mutation system polymerase chain reaction（multi-ARMS PCR） technique.Results Delirium occurred in 45 patients during the first three postoperative days.Of the 212 patients,18（8.5%） possessed one or two ApoE ε4 allele.There was no significant difference between delirious patients and non-delirious patients（6.7%： 9.0%,P〉0.05） in the presence of ApoE ε4 allele.In all four ApoE ε4/4 homozygote patients,one female patient presented a transient delirium status three days before surgery,another male patient presented serious fluctuated delirium symptoms from the second to 17th days after operation.Conclusion The presence of ApoE ε4 allele seems not a predictator of postoperative delirium.ApoE ε4/4 homozygote patients may be more indulgent to delirium than others.