Clinical study of APOE gene polymorphism combined with atorvastation in the treatment of chronic subdural hematoma

Abstract

Objective To explore the effect of APOE gene polymorphism on the clinical efficacy combined with oral atorvastatin in the treatment of chronic subdural hematoma (CSDH). Methods A total of 104 patients with CSDH admitted in The First People's Hospital of Foshan from January 2022 to December 2023 were selected as the research subjects. The APOE gene of the extracted DNA samples of the patients was detected by real-time fluorescence quantitative polymerase chain reaction (PCR) technology, and 104 patients were divided into APOE2 type group (n = 9), APOE3 type group (n = 58) and APOE4 type group (n = 37) according to the genotype. All patients were treated with oral atorvastatin therapy for 3 months. The clinical efficacy, health status [Karnofsky Performance Status (KPS)], hematoma clearance, complication and recurrence of each group were compared. Results The total effective rate (Fisher's exact probability: P = 0.011) and recurrence rate (Fisher's exact probability: P = 0.046) among the 3 groups were statistically significant. Further pairwise comparison showed that the total effective rate of APOE3 type group was higher (Fisher's exact probability: P = 0.045) and the recurrence rate was lower (Fisher's exact probability: P = 0.045) than the APOE2 type group. There were significant differences in KPS score, hematoma volume and hematoma area among the 3 groups (P = 0.000, for all). Further pairwise comparison between the groups showed that the APOE3 type group had higher KPS score (P = 0.009), larger hematoma volume (P = 0.000) and hematoma area (P = 0.000) before treatment than the APOE2 type group. The APOE4 type group had a larger hematoma volume than the APOE2 type group (P = 0.038). After one month of treatment, the KPS score of APOE3 type group was higher than that of APOE2 type group (P = 0.000) and APOE4 type group (P = 0.000), and the hematoma volume and hematoma area of APOE3 type group were smaller than those of APOE2 type group (P = 0.000, 0.000) and APOE4 type group (P = 0.000, 0.000). At the 3 months treatment, the KPS score of APOE3 type group was higher than that of APOE2 type group (P = 0.007), and the hematoma area was smaller than that of APOE2 type group (P = 0.046). Comparison of the same group at different observation time points showed that the KPS scores of APOE2 type group, APOE3 type group and APOE4 type group at one month after treatment were higher than those before treatment (P = 0.000, 0.000, 0.000), and the KPS scores at 3 months of treatment were higher than those before treatment (P = 0.000, 0.000, 0.000) and one month after treatment (P = 0.001, 0.000, 0.000); the hematoma volume (P = 0.000, 0.000, 0.000) and hematoma area (P = 0.000, 0.000, 0.000) at one month of treatment in the 3 groups were lower than those before treatment, and the hematoma volume and hematoma area at 3 months of treatment were lower than those before treatment (hematoma volume: P = 0.000, 0.000, 0.000; hematoma volume: P = 0.000, 0.000, 0.000) and one month after treatment (hematoma volume: P = 0.002, 0.000, 0.000; hematoma volume: P = 0.000, 0.000, 0.000). There was an interaction between the treatment factors of KPS score, hematoma volume and hematoma area and the measurement time (P = 0.000, for all). The changes of KPS score, hematoma volume and hematoma area in APOE3 type group were the largest, suggested that the APOE3 type group had the largest response to atorvastatin treatment and the best treatment effect. Conclusions The polymorphism of the APOE gene is closely related to the therapeutic effect of oral atorvastatin in patients with CSDH, and patients with APOE3 type show the best efficacy and safety, which is help for the formulation of personalized treatment plans for CSDH.

Keywords

• hematoma， subdural， chronic
• apolipoproteins e
• polymorphism， genetic
• atorvastatin