Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Psiquiàtric Universitari Institut Pere Mata, IISPV, C/Institut Pere Mata, S/N, 43206, Reus, Spain.
Universitat Rovira i Virgili, Tarragona, Spain.
Eur Arch Psychiatry Clin Neurosci. 2021 Aug;271(5):929-939. doi: 10.1007/s00406-021-01255-x. Epub 2021 Mar 29.
The objective is to understand genetic predisposition to delirium. Following PRISMA guidelines, we undertook a systematic review of studies involving delirium and genetics in the databases of Pubmed, Scopus, Cochrane Library and PsycINFO, and performed a meta-analysis when appropriate. We evaluated 111 articles, of which 25 were finally included in the analysis. The studies were assessed by two independent researchers for methodological quality using the Downs and Black Tool and for genetic analysis quality. We performed a meta-analysis of 10 studies of the Apolipoprotein E (APOE) gene, obtaining no association with the presence of delirium (LOR 0.18, 95% CI - 0.10-0.47, p = 0.21). Notably, only 5 out of 25 articles met established criteria for genetic studies (good quality) and 6 were of moderate quality. Seven studies found an association with APOE4, the dopamine transporter gene SCL6A3, dopamine receptor 2 gene, glucocorticoid receptor, melatonin receptor and mitochondrial DNA haplotypes. One genome-wide association study found two suggestive long intergenic non-coding RNA genes. Five studies found no association with catechol-o-methyltransferase, melatonin receptor or several interleukins genes. The studies were heterogenous in establishing the presence of delirium. Future studies with large samples should further specify the delirium phenotype and deepen our understanding of interactions between genes and other biological factors.
目的是了解谵妄的遗传易感性。根据 PRISMA 指南，我们在 Pubmed、Scopus、Cochrane Library 和 PsycINFO 数据库中对涉及谵妄和遗传学的研究进行了系统综述，并在适当的情况下进行了荟萃分析。我们评估了 111 篇文章，其中 25 篇最终纳入分析。这些研究由两名独立的研究人员使用 Downs 和 Black 工具评估方法学质量，并评估遗传分析质量。我们对 10 项载脂蛋白 E (APOE) 基因的研究进行了荟萃分析，没有发现与谵妄的存在有关（比值比 0.18，95%置信区间 -0.10-0.47，p = 0.21）。值得注意的是，25 篇文章中只有 5 篇符合遗传研究的既定标准（高质量），6 篇为中等质量。有 7 项研究发现与 APOE4、多巴胺转运体基因 SCL6A3、多巴胺受体 2 基因、糖皮质激素受体、褪黑素受体和线粒体 DNA 单倍型有关。一项全基因组关联研究发现了两个提示性长基因间非编码 RNA 基因。有 5 项研究发现与儿茶酚-O-甲基转移酶、褪黑素受体或几种白细胞介素基因无关。确定谵妄存在的研究存在异质性。未来的大样本研究应进一步明确谵妄表型，并加深我们对基因与其他生物因素之间相互作用的理解。
