Abstract：
BACKGROUND: Accurate evaluation of level of disorder of consciousness (DOC) is clinically challenging.
OBJECTIVE: This study aimed to establish a distinctive DOC-related pattern (DOCRP) for assessing disease severity and distinguishing unresponsive wakefulness syndrome (UWS) from minimally conscious state (MCS).
METHODS: Fifteen patients with DOC and eighteen health subjects with F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET) were enrolled in this study. All patients were assessed by Coma Recovery Scale-Revised (CRS-R) and all individuals were randomly divided into two cohorts (Cohort A and B). DOCRP was identified in Cohort A and subsequently validated in Cohort B and A+B. We also assessed the discriminatory power of DOCRP between MCS and UWS.
RESULTS: The DOCRP was characterized bilaterally by relatively decreased metabolism in the medial and lateral frontal lobes, parieto-temporal lobes, cingulate gyrus and caudate, associated with relatively increased metabolism in the cerebellum and brainstem. DOCRP expression exhibited high accuracy in differentiating DOC patients from controls (P<0.0001, AUC=1.000), and furthermore could effectively distinguish MCS from UWS (P=0.037, AUC=0.821, sensitivity: 85.7 %, specificity: 75.0 %). Particularly in the subgroup of DOC patients survived global hypoxic-ischemic brain injury, DOCRP expression exhibited even better discriminatory power between MCS and UWS (P=0.046, AUC=1.000).
CONCLUSIONS: DOCRP might serve as an objective biomarker in distinguishing between UWS and MCS, especially in patients survived global hypoxic-ischemic brain injury.
BACKGROUND: ChiCTR2300073717 (Chinese clinical trial registry site, http://www.chictr.org).
OBJECTIVE: This study aimed to establish a distinctive DOC-related pattern (DOCRP) for assessing disease severity and distinguishing unresponsive wakefulness syndrome (UWS) from minimally conscious state (MCS).
METHODS: Fifteen patients with DOC and eighteen health subjects with F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET) were enrolled in this study. All patients were assessed by Coma Recovery Scale-Revised (CRS-R) and all individuals were randomly divided into two cohorts (Cohort A and B). DOCRP was identified in Cohort A and subsequently validated in Cohort B and A+B. We also assessed the discriminatory power of DOCRP between MCS and UWS.
RESULTS: The DOCRP was characterized bilaterally by relatively decreased metabolism in the medial and lateral frontal lobes, parieto-temporal lobes, cingulate gyrus and caudate, associated with relatively increased metabolism in the cerebellum and brainstem. DOCRP expression exhibited high accuracy in differentiating DOC patients from controls (P<0.0001, AUC=1.000), and furthermore could effectively distinguish MCS from UWS (P=0.037, AUC=0.821, sensitivity: 85.7 %, specificity: 75.0 %). Particularly in the subgroup of DOC patients survived global hypoxic-ischemic brain injury, DOCRP expression exhibited even better discriminatory power between MCS and UWS (P=0.046, AUC=1.000).
CONCLUSIONS: DOCRP might serve as an objective biomarker in distinguishing between UWS and MCS, especially in patients survived global hypoxic-ischemic brain injury.
BACKGROUND: ChiCTR2300073717 (Chinese clinical trial registry site, http://www.chictr.org).
摘要：
背景：准确评估意识障碍（DOC）的水平在临床上具有挑战性。
目的：本研究旨在建立一种独特的DOC相关模式（DOCRP），用于评估疾病严重程度并区分无反应的觉醒综合征（UWS）与最低意识状态（MCS）。
方法：本研究纳入了15例DOC患者和18例F-18-氟脱氧葡萄糖（F-18-FDG）正电子发射断层扫描（PET）健康受试者。所有患者均通过昏迷恢复量表（CRS-R）进行评估，并将所有个体随机分为两组（队列A和B）。在队列A中鉴定了DOCRP，随后在队列B和A+B中进行了验证。我们还评估了DOCRP在MCS和UWS之间的区分能力。
结果：DOCRP的双侧特征是内侧和外侧额叶的代谢相对减少，顶颞叶,扣带回和尾状回，与小脑和脑干代谢相对增加有关。DOCRP表达在区分DOC患者与对照组方面表现出很高的准确性（P<0.0001，AUC=1.000），并且可以有效区分MCS和UWS（P=0.037，AUC=0.821，灵敏度：85.7％，特异性：75.0%）。特别是在DOC患者的亚组中，在整体缺氧缺血性脑损伤中幸存下来，DOCRP表达在MCS和UWS之间表现出更好的区分能力（P=0.046，AUC=1.000）。
结论：DOCRP可能作为区分UWS和MCS的客观生物标志物，尤其是在整体缺氧缺血性脑损伤中存活的患者。
背景：ChiCTR2300073717（中国临床试验注册中心，http://www。chictr.org)。
目的：本研究旨在建立一种独特的DOC相关模式（DOCRP），用于评估疾病严重程度并区分无反应的觉醒综合征（UWS）与最低意识状态（MCS）。
方法：本研究纳入了15例DOC患者和18例F-18-氟脱氧葡萄糖（F-18-FDG）正电子发射断层扫描（PET）健康受试者。所有患者均通过昏迷恢复量表（CRS-R）进行评估，并将所有个体随机分为两组（队列A和B）。在队列A中鉴定了DOCRP，随后在队列B和A+B中进行了验证。我们还评估了DOCRP在MCS和UWS之间的区分能力。
结果：DOCRP的双侧特征是内侧和外侧额叶的代谢相对减少，顶颞叶,扣带回和尾状回，与小脑和脑干代谢相对增加有关。DOCRP表达在区分DOC患者与对照组方面表现出很高的准确性（P<0.0001，AUC=1.000），并且可以有效区分MCS和UWS（P=0.037，AUC=0.821，灵敏度：85.7％，特异性：75.0%）。特别是在DOC患者的亚组中，在整体缺氧缺血性脑损伤中幸存下来，DOCRP表达在MCS和UWS之间表现出更好的区分能力（P=0.046，AUC=1.000）。
结论：DOCRP可能作为区分UWS和MCS的客观生物标志物，尤其是在整体缺氧缺血性脑损伤中存活的患者。
背景：ChiCTR2300073717（中国临床试验注册中心，http://www。chictr.org)。
