Characteristics of included studies.

The aim of systematic review and meta-analysis was to investigate whether APOE4 was associated with postoperative neurologic dysfunction occurrence in short- or medium-term among surgical patients and to study the potential genetic association among these two entities. We searched electronic databases for reserch studies to evaluate the association of APOE4 with postoperative delirium (POD) or short- and medium term postoperative cognitive dysfunction (POCD). Twenty-two trials (16 prospective and six retrospective) with 6734 patients were included. APOE4 alleles was shown significantly associated with POCD within 1 week (odds ratio, OR, 1.89, 95% confidence interval, CI, 1.36 to 2.6278, p < 0.01) in the random-effects model. A significant association was also noted between APOE4 and POCD in medium-term, 1–3 months, after surgery (OR: 1.67, 95% CI: 1.003–2.839, p = 0.049). However, APOE4 was not significantly associated with POCD 1 year after surgery (OR: 0.98, 95% CI: 0.57–1.70, p = 0.9449) and POD (OR: 1.28, 95% CI: 0.85–1.91, p = 0.23). In conclusion, APOE4 alleles was genetically associated with short- and medium-term postoperative neurological dysfunction and future screening or preventive strategies derived is highly potential to improve outcomes.

本研究旨在通过系统评价与荟萃分析（systematic review and meta-analysis），探讨手术患者术后中短期神经功能障碍的发生是否与载脂蛋白Eε4等位基因（APOE4）相关，并研究二者之间潜在的遗传关联。我们通过检索电子数据库中的相关研究，以评估APOE4与术后谵妄（postoperative delirium, POD）或中短期术后认知功能障碍（postoperative cognitive dysfunction, POCD）之间的关联。最终纳入22项研究（其中16项为前瞻性研究、6项为回顾性研究），共计6734例患者。在随机效应模型中，APOE4等位基因与1周内发生的POCD呈显著相关（比值比（odds ratio, OR）=1.89，95%置信区间（confidence interval, CI）=1.36~2.6278，p<0.01）。术后1~3个月的中期随访中，APOE4与POCD同样存在显著关联（OR=1.67，95%CI=1.003~2.839，p=0.049）。但术后1年时，APOE4与POCD并无显著关联（OR=0.98，95%CI=0.57~1.70，p=0.9449），且APOE4与POD亦无显著关联（OR=1.28，95%CI=0.85~1.91，p=0.23）。综上，APOE4等位基因与手术患者的中短期术后神经功能障碍存在遗传关联，未来基于该发现开发的筛查或预防策略有望改善患者预后。