Cognitive function after major noncardiac surgery, apolipoprotein E4 genotype, and biomarkers of brain injury.
Cognitive function after major noncardiac surgery, apolipoprotein E4 genotype, and biomarkers of brain injury.
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DOI：
10.1097/aln.0b013e3181d31fd7
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发表时间：
2010-04
期刊：
影响因子：
8.8
通讯作者：
Neurologic Outcome Research Group
中科院分区：
文献类型：
--
作者：
McDonagh DL;Mathew JP;White WD;Phillips-Bute B;Laskowitz DT;Podgoreanu MV;Newman MF;Neurologic Outcome Research Group
术后认知功能障碍(POCD)是非心脏手术后并发症的重要原因。已确定的风险因素在很大程度上仅限于人口特征。我们假设POCD与载脂蛋白E4(APOE4)基因和脑损伤和炎症的血浆生物标志物相关。394名年龄在55岁以上的非心脏手术患者参加了这项前瞻性观察研究。基线时进行载脂蛋白E基因分型。分别于基线、手术结束、术后4.5、24和48小时采集血浆。检测6种蛋白质生物标志物(B型利钠肽、C反应蛋白、D-二聚体、基质金属蛋白酶-9、神经元特异性烯醇化酶、S-100B)。神经认知测试在基线、6周和术后1年进行；分数进行因素分析。用多变量回归模型检验APOE4和生物标记物与POCD的相关性。350名患者(89%)完成了为期6周的神经认知测试。54.3%的参与者在6周时发生POCD，46.1%的参与者在1年时发生POCD。APOE4等位基因携带者与无APOE4等位基因携带者之间POCD差异无统计学意义(56.6%vs.52.6%；p=0.58)。持续认知改变评分(Mean±SD)在两组间相似(APOE4：0.05±0.27对非APOE4：0.07±0.28；p=0.53)。291名受试者(74%)在1岁时完成测试。45.9%的APOE4受试者发生POCD，而非APOE4受试者的POCD发生率为46.3%(p=0.95)。认知评分再次相似(APOE4：0.08±0.27对非APOE4：0.05±0.25；p=0.39)。在6周或1岁时，生物标记物水平与APOE4基因型或认知能力无关。大型非心脏手术后认知功能下降与APOE4基因或血浆生物标记物水平无关。
Postoperative cognitive dysfunction (POCD) is a significant cause of morbidity after noncardiac surgery. Identified risk factors are largely limited to demographic characteristics. We hypothesized that POCD was associated with Apolipoprotein E4 (APOE4) genotype and plasma biomarkers of brain injury and inflammation. 394 patients over age 55 undergoing major elective noncardiac surgery were enrolled in this prospective observational study. Apolipoprotein E genotyping was performed at baseline. Plasma was collected at baseline, end of surgery, 4.5, 24, and 48-h postoperatively. Six protein biomarkers were assayed (B-type natriuretic peptide, C-reactive protein, D-dimer, matrix metalloproteinase-9, neuron specific enolase, S-100B). Neurocognitive testing was conducted at baseline, 6 weeks, and 1 yr after surgery; scores were subjected to factor analysis. The association of APOE4 and biomarkers with POCD was tested using multivariable regression modeling. 350 patients (89%) completed 6-week neurocognitive testing. POCD occurred in 54.3% of participants at 6 weeks and 46.1% at 1 yr. There was no difference in POCD between patients with or without the APOE4 allele (56.6 vs. 52.6%; p = 0.58). The continuous cognitive change score (mean ± SD) was similar between groups (APOE4: 0.05 ± 0.27 vs. non-APOE4: 0.07 ± 0.28; p = 0.53). 291 subjects (74%) completed testing at 1 yr. POCD occurred in 45.9% of APOE4 subjects versus 46.3% of non-APOE4 subjects (p = 0.95). The cognitive score was again similar (APOE4: 0.08 ± 0.27 vs. non-APOE4: 0.05 ± 0.25; p = 0.39). Biomarker levels were not associated with APOE4 genotype or cognition at 6 weeks or 1 yr. Cognitive decline after major noncardiac surgery is not associated with APOE4 genotype or plasma biomarker levels.