Traumatic Brain Injury Center of Excellence, 1335 E W Hwy, Silver Spring, MD, 20910, United States; Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, United States; National Intrepid Center of Excellence, Palmer Rd S, Bethesda, MD, 20814, United States; University of British Columbia, Vancouver, BC, V6T 1Z4, Canada; Contractor, General Dynamics Information Technology, 3150 Fairview Park Dr, Falls Church, VA, 22042, United States; Centre of Excellence on Post-traumatic Stress Disorder, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada.
VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, United States; University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States.
Behav Brain Res. 2021 Oct 11;415:113491. doi: 10.1016/j.bbr.2021.113491. Epub 2021 Jul 29.
Past research has found a relationship between the apolipoprotein E (APOE) e4 allele and worse neurobehavioral functioning following mild traumatic brain injury (MTBI) in civilian populations. The purpose of this study was to examine this relationship in service members and veterans (SMVs) following MTBI. Participants were 151 SMVs (103 uncomplicated MTBI; 48 Injured Controls [IC]) prospectively enrolled in the DVBIC-TBICoE 15-Year Longitudinal TBI Study. Participants completed a battery of self-reported neurobehavioral symptom measures on average 76.2 months post-injury (SD = 31.8). APOE genotyping was undertaken using non-fasting blood samples. Participants were classified into four subgroups based on injury (MTBI vs. IC) and APOE e4 allele status (e4 present/absent). In the IC group, there were no significant differences across APOE e4 status subgroups for all measures. In the MTBI group, participants with the APOE e4 allele had significantly worse scores on measures of depression, pain, anxiety, grief, positive well-being, social participation, and resilience compared to those without the e4 allele (d = .44 to d = .69). When comparing the number of 'clinically elevated' neurobehavioral measures simultaneously, the MTBI/e4 present subgroup consistently had a higher number of elevated measures compared to the MTBI/e4 absent, IC/e4 present, and IC/e4 absent subgroups. The APOE e4 allele was associated with poorer neurobehavioral outcome in SMVs in the chronic phase of recovery following MTBI. APOE e4 could be incorporated into screening tools to predict SMVs at risk for poor long-term neurobehavioral outcome in an effort to provide early intervention to improve long-term clinical outcome.
过去的研究发现，载脂蛋白 E (APOE) e4 等位基因与平民人群轻度创伤性脑损伤 (MTBI) 后的神经行为功能恶化有关。本研究的目的是在 MTBI 后的军人和退伍军人 (SMV) 中检验这种关系。参与者是 151 名 SMV（103 名无并发症 MTBI；48 名受伤对照 [IC]），前瞻性地参加了 DVBIC-TBICoE 15 年纵向 TBI 研究。参与者在受伤后平均 76.2 个月（SD = 31.8）完成了一系列自我报告的神经行为症状测量。使用非禁食血液样本进行 APOE 基因分型。根据损伤（MTBI 与 IC）和 APOE e4 等位基因状态（e4 存在/缺失）将参与者分为四组。在 IC 组中，e4 状态亚组在所有测量中均无显著差异。在 MTBI 组中，携带 APOE e4 等位基因的参与者在抑郁、疼痛、焦虑、悲伤、积极幸福感、社会参与度和适应力方面的得分明显低于不携带 e4 等位基因的参与者（d =.44 至 d =.69）。当比较同时出现的“临床显著升高”的神经行为测量数量时，MTBI/e4 存在亚组的升高测量数量始终高于 MTBI/e4 不存在、IC/e4 存在和 IC/e4 不存在亚组。APOE e4 等位基因与 MTBI 后慢性恢复期 SMV 的神经行为结果较差相关。APOE e4 可纳入筛选工具，以预测 SMV 存在长期神经行为结局不良的风险，从而提供早期干预以改善长期临床结局。
