摘要
目的探讨载脂蛋白E(ApoE)4表型与肝移植患者术后认知功能障碍(POCD)的关系。方法选取50例肝移植患者,应用酶联免疫吸附试验定量测定患者术前的血清ApoE4和ApoE水平,根据ApoE4/ApoE的比值确定患者的ApoE表型,将其分为ApoE4组和非ApoE4组。术前、术后3和7d分别对患者进行简明精神状态量表(MMSE)评分。结果共有40例患者完成术后随访,其中ApoE4组13例(32.5%)。两组间年龄、性别构成、体重、术前总胆红素水平、术前肝功能分级(Child分级)、手术时间、无肝期时间、失血量、输血量(包括自体血)、补液量(晶体和胶体)的差异均无统计学意义(P值均>0.05)。在术前,无肝期10、30、60min,新肝期10、30min及术毕,两组间平均动脉压、心率、中心静脉压、血红蛋白的差异均无统计学意义(P值均>0.05)。术后3、7dApoE4组的MMSE评分分别为(26.0±2.0)和(25.6±2.3)分,非ApoE4组分别为(24.8±2.6)和(25.9±2.1)分,分别较同组术前的(29.0±0.7)和(28.5±0.8)分显著下降(P值均<0.05),但两组间的差异均无统计学意义(P值均>0.05)。ApoE4组和非ApoE4组术后3d的POCD发生率分别为53.8%和62.9%,术后7d分别为46.2%和40.7%,差异均无统计学意义(P值均>0.05)。结论肝移植患者ApoE4表型与POCD的发生无关。
Objective To investigate the relationship between apolipoprotein E （ApoE） 4 phenotype and postoperative cognitive dysfunction （POCD） in the patients with liver transplantation. Methods Blood samples from 50 liver transplantation patients were obtained before induction of anesthesia to detect serum ApoE4 and ApoE concentrations by enzyme-linked immunosorbent assay （ELISA）. ApoE phenotypes were identified according to the concentration ratio between ApoE4 and ApoE. Then the patients were divided into ApoE4 group and non-ApoE4 group, and evaluated with mini-mental state examination （MMSE） for cognitive function before induction of anesthesia, 3 d and 7 d after surgery. Results Totally 40 patients completed follow up in this study. There were 13 patients （32.5%） with ApoE4 phenotype. No significant differences in age, gender, body weight, preoperative liver function （serum total bilirubin, Child-pugh classification）, operation time, anhepatic phase, blood loss and infusion （autoreinfusion was included）, of fluid infusion were found between two groups （ P〉0.05）. Meanwhile, we measured the mean artery pressure, heart rate, central venous pressure and hemoglobin of the 40 patients before surgery, at 10, 30, and 60 mins of anhepatic phase, at 10 and 30 mins of new hepatic phase, and at the end of the surgery; and there were no significant differences in these data between two groups （all P〉0.05）. On day 3 and day 7 after surgery, MMSE scores were 26.0 ±2.0 and 25.6 ± 2.3 in ApoE4 group and 24.8 ± 2.6 and 25.9± 2. 1 in non-ApoE4 group, which were significantly lower than the preoperative scores （29.0±0.7 and28.5±0.8, P〈0.05）. However, there were no significant differences in MMSE between the two groups at different time points （P〉0.05）. The incidence rates of POCD in ApoE4 and non-ApoE4 groups were 53.8% and 62.9% （P=0.62） on day 3 after transplantation and were 46.2% and 40.7% （P=0.83） on day 7 after transplantation. Conclusion ApoE4 is not associated with POCD after liver transplantation.
出处
《上海医学》
CAS
CSCD
北大核心
2012年第6期492-495,共4页
Shanghai Medical Journal
基金
上海市器官移植临床医学中心基金资助项目(QY040101-2-04)
关键词
载脂蛋白E4
肝移植
术后认知功能障碍
Apolipoprotein E4
Liver transplantation
Postoperative cognitive dysfunction
