Ost M, Nylén K, Csajbok L, Blennow K, Rosengren L, Nellgård B
Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta Anaesthesiol Scand. 2008 Nov;52(10):1364-9. doi: 10.1111/j.1399-6576.2008.01675.x.
Traumatic brain injury (TBI) is one of the most common causes of death and dismal outcome among children and young adults. The morbidity and mortality differ but more aggressive monitoring and more designated neuro intensive care units have improved the results. Studies have demonstrated a connection between apolipoprotein E (APOE) genotype and outcome after TBI, but few are prospective and none is from northern Europe. APOE has three alleles: epsilon2, epsilon3 and epsilon4.
A total of 96 patients with Glasgow coma score (GCS) < or =8 were prospectively and consecutively included. APOE genotypes were all analyzed at the same laboratory from blood samples by polymerase chain reaction-restriction fragment length polymorphism.
All patients were assessed at 1 year with Glasgow outcome scale extended (GOSE), National Institute of Health Stroke Scale (NIHSS) and the Barthel daily living index. The genotype was available in all patients. Twenty-six patients expressed APOE epsilon4 while 70 patients did not. Outcome demonstrated that patients with APOE epsilon4 had worse outcome vs. those lacking this allele. When subdividing patients into gender, males with APOE epsilon4 did worse, a difference not detected among female patients.
APOE epsilon4 correlated to worse outcome in TBI patients. We also found that males with APOE epsilon4 had poor outcome while females did not. Thus, the results indicate that genetic polymorphism may influence outcome after TBI.
创伤性脑损伤（TBI）是儿童和年轻人死亡及预后不良的最常见原因之一。发病率和死亡率有所不同，但更积极的监测和更多专门的神经重症监护病房改善了治疗结果。研究表明载脂蛋白E（APOE）基因型与TBI后的预后之间存在关联，但前瞻性研究较少，且没有来自北欧的研究。APOE有三个等位基因：ε2、ε3和ε4。
前瞻性连续纳入96例格拉斯哥昏迷评分（GCS）≤8分的患者。所有患者的APOE基因型均在同一实验室通过聚合酶链反应-限制性片段长度多态性分析血样。
所有患者在1年时均采用扩展格拉斯哥预后量表（GOSE）、美国国立卫生研究院卒中量表（NIHSS）和巴氏日常生活指数进行评估。所有患者的基因型均已确定。26例患者表达APOE ε4，70例患者未表达。结果表明，与缺乏该等位基因的患者相比，携带APOE ε4的患者预后更差。将患者按性别细分后发现，携带APOE ε4的男性患者预后更差，而女性患者中未发现这种差异。
APOE ε4与TBI患者预后较差相关。我们还发现，携带APOE ε4的男性患者预后不良，而女性患者则不然。因此，结果表明基因多态性可能影响TBI后的预后。
