Apolipoprotein E Genotype Modifies the Risk of Behavior Problems After Infant Cardiac Surgery

作者：Gaynor J William^*; Nord Alex S; Wernovsky Gil; Bernbaum Judy; Solot Cynthia B; Burnham Nancy; Zackai Elaine; Heagerty Patrick J; Clancy Robert R; Nicolson Susan C; Jarvik Gail P; Gerdes Marsha

来源：Pediatrics, 2009, 124(1): 241-250.

DOI：10.1542/peds.2008-2281

• congenital heart defects
• genetic predisposition to disease
• apolipoprotein E
• behavioral symptoms
• attention-deficit/hyperactivity disorder
• impulsive behavior
• autistic disorder

OBJECTIVE: The goal was to evaluate polymorphisms of the APOE gene as modifiers of neurobehavioral outcomes for preschool-aged children with congenital heart defects, after cardiac surgery.
METHODS: A prospective observational study with neurodevelopmental evaluation between the fourth and fifth birthdays was performed. Attention and behavioral skills were assessed through parental report.
RESULTS: Parents of 380 children completed the neurobehavioral measures. Child Behavior Checklist scores for the pervasive developmental problem scale were in the at-risk or clinically significant range for 15% of the cohort, compared with 9% for the normative data (P < .00001). Attention problem scores were in the at-risk or clinically significant range for 12% of the cohort, compared with 7% for the normative data (P = .0002). The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, Preschool Version, was completed for 378 children; 30% scored in the clinically significant range for inattention and 22% for impulsivity. After adjustment for covariates, the APOE is an element of 2 allele was significantly associated with higher scores ( worse problems) for multiple Child Behavior Checklist indices, including somatic complaints (P = .009), pervasive developmental problems (P = .032), and internalizing problems (P = .009). In each case, the is an element of 4 allele was associated with a better outcome. APOE is an element of 2 carriers had impaired social skills, compared with is an element of 4 carriers (P = .009).
CONCLUSIONS: For preschool-aged children with congenital heart defects requiring surgery, parental rating scales showed an increased prevalence of restricted behavior patterns, inattention, and impaired social interactions. The APOE is an element of 2 allele was associated with increased behavior problems, impaired social interactions, and restricted behavior patterns. Pediatrics 2009; 124: 241-250

• 出版日期2009-7