DRD2基因多态性与冠状动脉旁路移植术后谵妄的关联研究

目的 研究DRD2基因多态性与冠状动脉旁路移植术后谵妄的相关性以及危险因素.方法 以冠状动脉旁路移植手术住院患者为研究对象,连续纳入手术患者150例,以《谵妄分级量表-98修订版》作为谵妄诊断工具,分析术后谵妄的发生率和危险因素;采用基因测序法确定DRD2的多态性,分析rs6275、ts6277多态性与谵妄的相关性.结果 术后谵妄发生率8.0%(12/150例);组间单因素分析显示脑梗死 (OR=0.784,95%CI 0.631～0.975,P=0.024);手术持续时间(OR=2.251,95%CI 0.941～5.380,P=0.048);体外循环时间(OR=1.057,95%CI 0.703～1.590,P=0.029);ICU病房时间(OR=1.890,95%CI 1.201～2.973,P=0.005)差异有统计学意义(P<0.05);2组间rs6275基因型差异无统计学意义(OR=1.265,95%CI 0.697～2.303,P=0.651);rs6277基因型2组间分布差异有统计学意义(OR=2.276,95%CI 1.142～4.523,P=0.049);Logsistic多因素回归分析显示脑梗死(OR=1.861,95%CI 1.082～3.163,P=0.024)、ICU持续时间(OR=6.757,95%CI 2.376～19.267,P=0.001)、rs6277的CC基因型(OR=4.019,95%CI 1.395～12.341,P=0.012)是术后谵妄的危险因素.结论 对术前合并脑梗死的高危患者,进行DRD2基因筛查,有助于评估谵妄发生的可能性.

Correlation between dopamine D2 receptor gene polymorphism and postoperative delirium in patients undergoing coronary artery bypass grafting

Objective To investigate the correlation between dopamine D2 receptor (DRD2) gene polymorphism and postoperative delirium in patients undergoing coronary artery bypass grafting (CABG), and to analyze the risk factors of postoperative delirium.Methods A total 150 patients who underwent coronary artery bypass grafting were enrolled in the study.The incidence rate and risk factors of postoperative delirium were analyzed by taking 《Delirium rating scale 98 revised edition》as diagnosis criteria for delirium,moreover, DRD2 genotypes were detected by gene sequencing.The correlation between rs6275,rs6277 polymorphism and delirium was analyzed.Results The incidence rate of postoperative delirium was 8.0% (12/150).The interclass univariate Logistic regression analysis results showed there were significant differences in cerebral infarction (OR=0.784,95%CI 0.631～0.975,P<0.05),surgery duration (OR=2.251,95%CI 0.941～5.380,P<0.05), extracorporeal circulation time (OR=1.057,95%CI 0.703～1.590,P<0.05)and intensive care unit duration (OR=1.890,95%CI 1.201～2.973,P<0.01).However there were no significant differences in frequencies of genotype and alleles of rs6275 polymorphism between case group and control group (OR=1.265,95%CI 0.697～2.303,P>0.05),but there were significant differences in frequencies of genotype and alleles of rs6277 polymorphism between the two groups (OR=2.276, 95%CI 1.142～4.523,P<0.05).The Logistic multifactor stepwise regression analysis showed that cerebral infarction, ICU duration and CC genotype of rs6277 were risk factors of postoperative delirium (P<0.01 or P<0.05).Conclusion To perform DRD2 gene screening in cerebral infarction patients with high risk factors may be helpful for prevention of occurrence of postoperative delirium.