摘要【目的】探讨载脂蛋白E(ApoE)基因、临床特征与老年患者全麻术后认知功能障碍(POCD)的关系。【方法】本院收治的122例采用丙泊酚麻醉诱导全麻手术的老年患者,患者均行ApoE基因及基因型检测,并采用简易智力状态检查量表(MMSE)评估患者术后POCD发生情况。分析ApoE基因与老年丙泊酚麻醉诱导全麻术后POCD的关系。【结果】患者术前认知功能均正常,MMSE评分为(28.51±1.12)分,术后24 h MMSE评分为(26.01±1.32)分,术后72 h MMSE评分为(26.81±1.05)分,术后7 d MMSE评分为(27.41±1.06)分。发生POCD 36例,占29.51%,纳入POCD组;未发生POCD 86例,占70.49%,纳入非POCD组。POCD组患者年龄、ε3/4及ε4基因携带频率显著高于非POCD组(P<0.05),ε3/3基因型携带频率显著低于非POCD组(P<0.05)。多因素Logistic回归分析显示,年龄及ε3/3、ε3/4、ε4基因型携带情况是老年丙泊酚麻醉诱导全麻术后POCD的独立影响因素(P<0.05)。【结论】ApoE基因分布可能与老年丙泊酚麻醉诱导全麻术后POCD发生机制有关。
Abstract：【Objective】To study the relationship of postoperative cognitive dysfunction(POCD) with apolipoprotein E (ApoE) gene and clinical features in elderly patients after general anesthesia. 【Methods】A total of 122 elderly patients underwent general anesthesia with propofol in our hospital. All patients were tested for ApoE gene and genotype,while mini mental state examination (MMSE) was used to assess the incidence of postoperative cognitive dysfunction. The relationship between ApoE gene and cognitive dysfunction after propofol-induced general anesthesia in elderly patients was analyzed. 【Results】 The MMSE score was (28.51 ± 1.12) before operation. While the MMSE score was (26.01 ± 1.32) at 24 hours after operation,the MMSE score was (26.81 ± 1.05) at 72 hours after operation,and the MMSE score was (27.41 ± 1.06) on 7 days after operation. The results showed that 36 cases (29.51%) had POCD and 86 cases (70.49%) had no POCD. The age and ApoE gene carrying frequency (epsilon 3/4 and epsilon 4 gene) of the POCD group were significantly higher than those of the non POCD group (P<0.05). However,the epsilon 3/3 genotype carrying frequency of the POCD group was significantly lower than that of the non POCD group (P<0.05). Multivariate logistic regression analysis showed that age,epsilon 3/3,epsilon 3/4 and epsilon 4 were independent influencing factors of POCD after propofol anesthesia induction in the elderly patients (P<0.05). 【Conclusion】The distribution of ApoE gene may be related to the mechanism of POCD dysfunction induced by propofol anesthesia in the elderly patients.
卢志方, 刘小兵. 载脂蛋白E基因、临床特征与老年患者全麻术后认知功能障碍的相关性[J]. 医学临床研究, 2023, 40(8): 1183-1185.
LU Zhi-fang, LIU Xiao-bing. Relationship of Postoperative Cognitive Dysfunction with ApoE Gene and Clinical Features in Elderly Patients after General Anesthesia. JOURNAL OF CLINICAL RESEARCH, 2023, 40(8): 1183-1185.
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2023, Vol. 40 
