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).
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)。