载脂蛋白 E ε4 与丹麦中老年双胞胎手术后的认知功能。
Apolipoprotein E ε4 and cognitive function after surgery in middle-aged and elderly Danish twins.
机构信息
From the The Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, Danish Twin Registry, Danish Aging Research Center, University of Southern Denmark (UD, MW, MT, KC, JM-F), Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense (TGH), Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen (LSR), Clinical Biochemistry and Pharmacology (KC) and Clinical Genetics, Odense University Hospital, Odense, Denmark (KC, JM-F).
出版信息
Eur J Anaesthesiol. 2020 Nov;37(11):984-991. doi: 10.1097/EJA.0000000000001250.
BACKGROUND
Transient cognitive impairment is common in adult patients of all ages following anaesthesia and surgery. Apolipoprotein E (APOE) ε4 carriers may have a larger deterioration in short-term cognitive function after major surgery compared with APOE ε4 noncarriers.
OBJECTIVES
The aim was to examine the effect of APOE ε4 on the association between exposure to surgery and anaesthesia, and subsequent cognitive functioning. A more pronounced deterioration in cognitive function in APOE ε4 carriers was hypothesised.
DESIGN
An observational cross-sectional and a 6 to 10 years longitudinal twin cohort design.
SETTING
Survey and register study of 2936 Danish twins aged 45 to 92 years.
MAIN OUTCOME MEASURES
Cognitive function was assessed using five age-sensitive cognitive tests. In the cross-sectional study, we compared twins exposed to surgery with a reference group (unexposed). Linear regression models were used adjusting for sex and age and stratified by APOE ε4 carrier status. In the longitudinal cognitive follow-up study 1671 twins participated. Intrapair analyses were also performed using 70 same-sexed twin pairs concordant for APOE ε4 carrier status, but discordant for major surgery.
RESULTS
APOE ε4 carriers had lower cognitive scores compared with noncarriers, and this was statistically significant in elderly twins 70+ years of age (mean difference, -0.67; 95% CI, -1.14 to -0.17). There was no significant impact on cognitive function after surgery according to APOE ε4 carrier status in the cross-sectional study. Similarly, there was no APOE ε4 modification in the longitudinal study. Also, in the intrapair analyses no evidence was found of lower cognitive score after major surgery compared with the nonexposed cotwins among APOE ε4 carriers.
CONCLUSION
No evidence was found of more pronounced long-term deterioration in cognitive function after surgery among APOE ε4 carriers, but elderly APOE ε4 carriers in general performed worse on the cognitive tests than noncarriers.
背景
在接受麻醉和手术的所有年龄段的成年患者中，短暂性认知障碍很常见。与 APOE ε4 非携带者相比，APOE ε4 携带者在大手术后短期认知功能可能会出现更大的恶化。
目的
本研究旨在研究 APOE ε4 对手术和麻醉暴露与随后认知功能之间关联的影响。假设 APOE ε4 携带者的认知功能恶化更明显。
设计
一项观察性的横断面和 6 至 10 年的纵向双胞胎队列设计。
地点
丹麦对 2936 名年龄在 45 至 92 岁的双胞胎进行的调查和登记研究。
主要观察指标
使用 5 种年龄敏感的认知测试评估认知功能。在横断面研究中，我们将接受手术的双胞胎与对照组（未暴露组）进行比较。使用线性回归模型调整性别和年龄，并按 APOE ε4 携带者状态进行分层。在纵向认知随访研究中，有 1671 对双胞胎参与。还对 70 对同性别、APOE ε4 携带者状态一致但大手术不一致的双胞胎进行了配对分析。
结果
APOE ε4 携带者的认知评分低于非携带者，70 岁及以上的老年双胞胎中差异具有统计学意义（平均差异，-0.67；95%CI，-1.14 至-0.17）。在横断面研究中，根据 APOE ε4 携带者状态，手术对认知功能没有显著影响。同样，在纵向研究中也没有 APOE ε4 修饰。此外，在配对分析中，在 APOE ε4 携带者中，也没有发现大手术后认知评分比未暴露的双胞胎低的证据。
结论
在 APOE ε4 携带者中，没有发现手术会导致认知功能更明显的长期恶化，但一般来说，老年 APOE ε4 携带者在认知测试中的表现比非携带者差。
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