背景和目的:大多数心脏骤停成功复苏的患者仍处于昏迷状态,被捕后72小时,只有一半人恢复了意识。神经预测方法可能是复杂的,甚至是不确定的。由于线粒体成分已被确定为心脏骤停后损伤的标志物,并与生存有关,我们旨在研究心脏骤停后昏迷患者的细胞色素c和mtDNA,以比较神经系统预后并评估这些标志物的神经预后价值。材料和方法:这项前瞻性观察研究包括86例心脏骤停后昏迷患者和10例健康对照。入院时测定细胞色素c和mtDNA。72小时后测量神经元特异性烯醇化酶(NSE)。当患者保持无意识时,执行其他神经预后方法。确定脑表现类别(CPC)。结果:与健康对照组相比,患者的细胞色素c升高(2.029[0.85-4.97]ng/mL与0[0.0-0.16],p<0.001),但不是mtDNA(95,228[52,566-194,060]vs.41,466[28,199-104,708]拷贝/μL,p=0.074)。与CPC1-2患者相比,CPC3-5患者的细胞色素c更高(1.735[0.717-3.40]vs.4.109[1.149-8.457]ng/mL,p=0.011),mtDNA没有差异(87,855[47,598-172,464]vs.126,452[69,447-260,334]拷贝/μL,p=0.208)。CPC1-2和CPC3-5患者在所有神经预后方法上均不同。在良好的患者与神经学结果不佳,细胞色素c的ROCAUC为0.664(p=0.011),mtDNA为0.582(p=0.208),NSE为0.860(p<0.001)。NSE与细胞色素c的相关性中等,系数为0.576(p<0.001)。结论:与健康对照组相比,心脏骤停后昏迷患者的细胞色素c更高,而神经系统预后较差的心脏骤停后患者的细胞色素c更高。尽管细胞色素c与NSE相关,其神经预后价值较差。我们发现mtDNA没有差异。
Background and Objectives: Most patients who are successfully resuscitated from cardiac arrest remain comatose, and only half regain consciousness 72 h after the arrest. Neuroprognostication methods can be complex and even inconclusive. As mitochondrial components have been identified as markers of post-cardiac-arrest injury and associated with survival, we aimed to investigate cytochrome c and
mtDNA in comatose patients after cardiac arrest to compare neurological outcomes and to evaluate the markers\' neuroprognostic value. Materials and Methods: This prospective observational study included 86 comatose post-cardiac-arrest patients and 10 healthy controls. Cytochrome c and
mtDNA were determined at admission. Neuron-specific enolase (NSE) was measured after 72 h. Additional neuroprognostication methods were performed when patients remained unconscious. Cerebral performance category (CPC) was determined. Results: Cytochrome c was elevated in patients compared to healthy controls (2.029 [0.85-4.97] ng/mL vs. 0 [0.0-0.16], p < 0.001) but not
mtDNA (95,228 [52,566-194,060] vs. 41,466 [28,199-104,708] copies/μL, p = 0.074). Compared to patients with CPC 1-2, patients with CPC 3-5 had higher cytochrome c (1.735 [0.717-3.40] vs. 4.109 [1.149-8.457] ng/mL, p = 0.011), with no differences in
mtDNA (87,855 [47,598-172,464] vs. 126,452 [69,447-260,334] copies/μL, p = 0.208). Patients with CPC 1-2 and CPC 3-5 differed in all neuroprognostication methods. In patients with good vs. poor neurological outcome, ROC AUC was 0.664 (p = 0.011) for cytochrome c, 0.582 (p = 0.208) for mtDNA, and 0.860 (p < 0.001) for NSE. The correlation between NSE and cytochrome c was moderate, with a coefficient of 0.576 (p < 0.001). Conclusions: Cytochrome c was higher in comatose patients after cardiac arrest compared to healthy controls and higher in post-cardiac-arrest patients with poor neurological outcomes. Although cytochrome c correlated with NSE, its neuroprognostic value was poor. We found no differences in
mtDNA.