Apolipoprotein E polymorphism and outcome after closed traumatic brain injury: influence of ethnic and regional differences
Apolipoprotein E polymorphism and outcome after closed traumatic brain injury: influence of ethnic and regional differences
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DOI：
10.3171/jns.2003.98.2.0302
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发表时间：
2003-02-01
影响因子：
4.1
通讯作者：
Naidoo, R
中科院分区：
文献类型：
--
作者：
Nathoo, N;Chetty, R;Naidoo, R
Object.载脂蛋白E-ε 4（APOE-ε 4）等位基因的存在与创伤性脑损伤（TBI）后预后不良有关。本研究旨在确定APOE-ε 4等位基因的存在是否会影响一组具有相同神经病理学结果的黑人TBI患者的预后。在入院时收集静脉血，以确定有创伤性脑挫伤的黑人祖鲁语患者的APOE基因型。APOE-ε 4等位基因的出现频率与至少6个月随访的结果相关。进行单因素和多因素分析，以确定独立的危险因素和控制混杂因素。在110名黑人祖鲁语的创伤性脑挫伤患者，APOE基因型进行了分析。45名携带APOE-ε 4等位基因的患者中有11人（24.4%）的结局较差，而65名不携带该等位基因的患者中有10人（15.4%）的结局较差（p = 0.34）。2例携带纯合子APOE-ε 4等位基因的患者均获得良好结局（格拉斯哥结局评分5）。单变量和多变量分析显示，APOE-ε 4等位基因患者的年龄、入院格拉斯哥昏迷评分、挫伤体积、神经外科治疗类型和预后无显著相关性。然而，携带APOE-ε 4等位基因的患者预后不良的风险更大（相对风险1.59; 95%可信区间0.74-3.42）。作者没有记录黑人TBI患者APOE-ε 4等位基因状态与预后之间的关系。鉴于APOE基因的高度区域易感性，可能需要进一步研究，甚至可能在其他地理区域进行基于社区的调查和研究。
Object. The presence of the apolipoprotein E-epsilon4 (APOE-epsilon4) allele is reported to be associated with poor outcome after traumatic brain injury (TBI). This study was performed to determine if the presence of the APOE-epsilon4 allele influenced outcome in a cohort of black patients with TBI who had homogeneous neuropathological findings.Methods. Venous blood was collected at the time of admission to determine the APOE genotype in black Zulu-speaking patients who presented with traumatic cerebral contusions. The frequency of the APOE-epsilon4 allele's appearance was correlated with outcome at a minimum of 6 months of follow up. Univariate and multivariate analyses were performed to determine independent risk factors and to control for confounding factors.In 110 black Zulu-speaking patients with traumatic cerebral contusions, genotypes for APOE were analyzed. Eleven of 45 (24.4%) with the APOE-epsilon4 allele experienced a poor outcome, compared with 10 (15.4%) of 65 without this allele (p = 0.34). Both patients with homozygous APOE-epsilon4 alleles experienced a good outcome (Glasgow Outcome Score 5). Univariate and multivariate analysis revealed no significant relationship in patients with the APOE-epsilon4 allele with regard to age, admission Glasgow Comas Scale score, contusion volume, type of neurosurgical management, and outcome. The risk of a poor outcome was, however, greater in patients with the APOE-epsilon4 allele (relative risk 1.59; 95% confidence interval 0.74-3.42).Conclusions. The authors recorded no relationship between APOE-epsilon4 allele status and outcome after TBI in black patients. Given the high regional susceptibility to the APOE gene, further studies, possibly even community-based investigations and studies conducted in other geographic areas, are probably warranted.