The Effect of Apolipoprotein E Gene Polymorphism on Cerebral Oxygen Metabolism and Postoperative Cognitive Function in Patients Undergoing Laparoscopic General Anesthesia Surgery
10.3870/j.issn.1672-0741.25.01.014
- VernacularTitle:载脂蛋白E基因多态性对腹腔镜全麻手术患者脑氧代谢及术后认知功能的影响
- Author:
Ying WEI
1
;
Xuewei YANG
1
Author Information
1. 天津市人民医院,南开大学第一附属医院麻醉科,天津 300121
- Publication Type:Journal Article
- Keywords:
apolipoprotein E;
genetic polymorphism;
laparoscopic general anesthesia surgery;
cerebral oxygen me-tabolism;
cognitive function
- From:
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
2025;54(3):377-387
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the effects of apolipoprotein E gene(ApoE)polymorphism on cerebral oxygen metabolism and postoperative cognitive function in patients undergoing laparoscopic general anesthesia surgery.Methods In this study,210 patients who underwent laparoscopic cholecystectomy in our hospital from January 2020 to January 2024 were selected and di-vided into ApoE ε2 group(45 cases,ε2/ε2,ε2/ε3),ApoE ε3 group(98 cases,ε3/ε3),and ApoE ε4 group(67 cases,ε3/ε4,ε4/ε4)based on their ApoE genotype.The general information,blood lipid levels,and cerebral oxygen metabolism index levels of each group were compared.Multiple linear regression analysis was conducted to investigate the relationship between ApoE gene poly-morphism,blood lipid levels,and cerebral oxygen metabolism indicators,and to analyze the correlation between blood lipid levels and oxygen metabolism indicators under different genotypes.Patients were divided into cognitive impairment group(n=54)and non-cognitive impairment group(n=156)based on whether they experienced cognitive impairment after surgery.General infor-mation,blood lipid levels,and cerebral oxygen metabolism indicators were compared between the two groups.Multivariate logis-tic regression analysis was conducted to identify the influencing factors of cognitive dysfunction.Restrictive cubic spline method was used to analyze the dose-response relationship between blood lipid levels,cerebral oxygen metabolism indicators,and cogni-tive impairment.The adjusted odds ratio(OR)and 95％confidence interval(CI)of ApoE gene polymorphism and cerebral oxygen metabolism indicators to the risk of cognitive impairment were estimated,and the interaction between ApoE gene polymorphism and cerebral oxygen metabolism indicators on cognitive impairment was analyzed.Results Among 210 patients undergoing lap-aroscopic general anesthesia surgery,the frequency of the ε3 allele was the highest,accounting for 71.67％,while the ε2 and ε4 alleles accounted for 11.90％and 16.43％,respectively.The highest proportion of the ε3/ε3 genotype was 46.67％(98/210),while the others were ε3/ε4(65/210),ε2/ε3(40/210),ε2/ε2(5/210),and ε4/ε4(2/210)in descending order.The total cholester-ol(TC),triglycerides(TG),and low-density lipoprotein cholesterol(LDL-C)of ApoE ε4 group patients were higher than those of ApoE ε2 group and ApoE ε3 group patients,while high-density lipoprotein cholesterol(HDL-C)was lower than that of ApoE ε2 group and ApoE ε3 group patients,and the differences were statistically significant(all P＜0.05).The difference in radial artery and internal jugular vein bulb oxygen content(DajvO2)in ApoE ε4 group patients was higher than that in ApoE ε2 group and ApoE ε3 group.The cerebral oxygen uptake rate(COER),internal jugular vein bulb oxygen content(CjvO2),and internal jugu-lar vein bulb oxygen saturation(SjvO2)were lower than those in ApoE ε2 group and ApoE ε3 group patients,and the differences were statistically significant(all P＜0.05).The TC,TG,LDL-C,HDL-C,COER,DajvO2,CjvO2,and SjvO2 levels were not cor-related with ApoE ε2 and ApoE ε3 types,but were correlated with ApoE ε4 type.The TC,TG,LDL-C,DajvO2 levels were posi-tively correlated with ApoE ε4 type,while HDL-C,COER,CjvO2,SjvO2 were negatively correlated with ApoE ε4 type(all P＜0.05).Under different genotypes,TC,TG,LDL-C were positively correlated with COER,CjvO2,and SjvO2(all P＜0.05),and negatively correlated with DajvO2(P＜0.05).HDL-C was negatively correlated with COER,CjvO2,and SjvO2(all P＜0.05),and positively correlated with DajvO2(P＜0.05).The differences in ApoE gene polymorphism,TC,TG,LDL-C,HDL,COER,DajvO2,CjvO2,and SjvO2 between patients with cognitive impairment and those without cognitive impairment were statistically significant(all P＜0.05).Multivariate logistic regression analysis showed that high TC,high TG,and ApoE ε4 genotypes were independent risk factors for cognitive dysfunction(all P＜0.05),while high COER and high SjvO2 were independent protective factors for cognitive dysfunction.The association intensity between TC,TG,LDL-C,HDL,COER,DajvO2,CjvO2,and SjvO2 and cognitive impairment showed a nonlinear dose-response relationship(P＜0.05).TC,TG,LDL-C,DajvO2 were positively correlated with the risk of cognitive impairment,while HDL-C,COER,CjvO2,and SjvO2 were negatively correlated with the risk of cognitive impairment.The interaction analysis of the generalized multifactor dimensionality reduction model showed that ApoE ε4 had interactions with COER,DajvO2,CjvO2,and SjvO2.Conclusion The polymorphism of ApoE gene is associated with cerebral oxygen metabolism in patients undergoing laparoscopic general anesthesia surgery.Among them,patients with ApoE ε4 genotype have a higher risk of cognitive dysfunction after surgery than those with ApoE ε2 and ApoE ε3 genotypes.Clinically,patients with ApoE ε4 genotype should strengthen intraoperative cerebral oxygen monitoring and achieve more accurate individualized anesthesia management based on their genotype.
