Relationship between the apolipoprotein E ?4 allele and cognitive dysfunction after coronary artery bypass grafting operation / 中华麻醉学杂志

ABSTRACT

Objective To investigate the relationship of apolipoprotein E ?4 allele to early cognitive dysfunction after cardiac surgery and to identify the predictors of cognitive decline after cardiac operation. Methods Two hundred and thirty patients aged over 18 yr undergoing coronary artery bypass grafting (CABG) were studied. They were capable of completing the preoperative cognitive function tests in terms of the education they had received. Patients with neurological or mental disease and those with serious hepato-renal or cardiac dysfunction were excluded. Cognitive function was evaluated using a battery of nine neuro-psychologieal tests before operation, at one week and 3 months after operation. Cognitive decline was defined as ≥20% decrement in 20% or more of the completed tests. The changes in the Z-based scores were used to evaluate the severity of cognitive decline. Logistic regression and multiple linear regression were used to determine the relationship of ApoE genotype to cognitive decline and identify the predictors of postoperative cognitive decline ( POCD) after cardiac operation. Results The incidence of cognitive decline was as high as 51.9 % and 21.0% at 1 week and 3 months after operation respectively. The ?4 allele was present in 7.4 % , ?3 allele in 86.1 % and ?2 allele in 6.5 % of the 230 patients. The cognitive decline was not significantly associated with the presence or absence of the ?4 allele. The ?4 allele was associated with poor baseline performance. Age, the use of cardiopulmonary bypass (CPB), duration of endotracheal intubation were predictors of cognitive impairment after cardiac operation. There was positive correlation between the neuro-psychological test scores at 1 week and 3 months after operation. Conclusion The results suggest that age, the use of CPB and duration of endotracheal intubation are the predictors of POCD. The ?4 allele is not associated with POCD after cardiac operation. The cognitive dysfunction at 3 months after operation is positively correlated with the level of cognitive decline at 1 week after operation.