摘要
目的 分析患者经心肺复苏后血清8-羟基脱氧鸟苷(8-OHdG)、脑源性神经营养因子(BDNF)、沉默信息调节因子1(SIRT1)水平变化及其在神经功能预后中的评估价值。方法 回顾性分析156例2022年2月—2024年4月康复大学青岛中心医院登记的心搏骤停后行心肺复苏患者的临床资料,依据神经功能预后评估分为预后良好组91例和预后不良组65例。采用酶联免疫吸附法检测不同时间点患者血清中8-OHdG、BDNF、SIRT1水平;采用Pearson法分析3个指标与神经功能预后的相关性;采用多因素Logistic回归分析神经功能预后的影响因素;采用受试者操作特征(ROC)曲线分析指标对预后的评估价值。结果 预后不良组机械通气时间、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分高于预后良好组,格拉斯哥昏迷量表(GCS)评分低于预后良好组(t=6.680、9.310,均P<0.05)。预后不良组心肺复苏后第1、3、7天血清8-OHdG水平呈上升趋势,BDNF、SIRT1呈下降趋势;心肺复苏后第3、7天预后不良组血清8-OHdG水平高于预后良好组,BDNF、SIRT1水平低于预后良好组(均P<0.05);时间因素和组间因素存在交互效应。8-OHdG与机械通气时间、APACHEⅡ评分呈正相关,与GCS评分呈负相关;BDNF、SIRT1与机械通气时间、APACHEⅡ评分呈负相关,与GCS评分呈正相关(均P<0.05)。心肺复苏后第3天血清8-OHdG水平是心搏骤停患者经心肺复苏后神经功能预后不良的独立危险因素,BDNF、SIRT1是保护因素(均P<0.05)。心肺复苏后第3天血清8-OHdG、BDNF、SIRT1水平单独及联合预测的曲线下面积(AUC)为0.819、0.844、0.852、0.947。结论 心搏骤停心肺复苏后神经功能预后不良患者血清8-OHdG水平升高,BDNF、SIRT1水平降低,三者联合有利于评估神经功能预后。
Objective To analyze the changes in serum levels of 8-hydroxydeoxyguanosine(8-OHdG),brain-derived neurotrophic factor(BDNF),and sirtuin 1(SIRT1)after cardiopulmonary resuscitation for patients with cardiac arrest,and their value in the prognosis of neurological function.Methods A retrospective analysis was conducted on the clinical data of 156 patients with cardiac arrest and cardiopulmonary resuscitation registered in Qingdao Central Hospital,University of Health and Rehabilitation Sciences from February 2022 to April 2024.Based on neurological functional prognosis evaluation,they were separated into a good prognosis group of 91 cases and a poor prognosis group of 65 cases.enzyme-linked im-munosorbent assay(ELISA)method was applied to detect the levels of 8-OHdG,BDNF,and SIRT1 in the serum of patients at different time points;the correlation between the three indicators and neurological prognosis was analyzed by Pearson method;multiple factor Logistic regression analysis was used to determine the factors affecting neurological prognosis;the value of receiver operator characteristic(ROC)curve analysis index for prognosis evaluation was studied.Results The mechanical ventilation time and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score of the poor prognosis group were higher than those of the good prognosis group,while the Glasgow coma scale(GCS)score was lower than that of the good prognosis group(t=6.680,9.310,all P<0.05).The poor prognosis group showed an upward trend in serum 8-OHdG level on the 1st,3rd,and 7th day after cardiopulmonary resuscitation,and a downward trend in BDNF and SIRT1.On the 3rd and 7th day after cardiopulmonary resuscitation,the serum 8-OHdG level in the poor prognosis group was higher than that in the good prognosis group,while BDNF and SIRT1 levels were lower than those in the good prognosis group(all P<0.05).There was an interactive effect among time factors and inter group factors.8-OHdG was positively correlated with mechanical ventilation time and APACHEⅡscore,and negatively correlated with GCS score.BDNF and SIRT1 were negatively correlated with mechanical ventilation time and APACHE II score,and positively correlated with GCS score(all P<0.05).The serum 8-OHdG level on the 3rd day after cardiopulmonary resuscitation was an independent risk factor for poor neurological prognosis after cardiac arrest and cardiopulmonary resuscitation,while BDNF and SIRT1 were protective factors(all P<0.05).The area under the curve(AUC)of serum 8-OHdG,BDNF,and SIRT1 levels alone and in combination on the 3rd day after cardiopulmonary resuscitation was 0.819,0.844,0.852,and 0.947.Conclusion Patients with poor neurological prognosis after cardiopulmonary resuscitation for cardiac arrest have elevated serum 8-OHdG level and decreased levels of BDNF and SIRT1.The combination of the three is beneficial for evaluating neurological prognosis.
作者
张辉
高静
刘森
许波
ZHANG Hui;GAO Jing;LIU Sen;XU Bo(Department of Laboratory,Yantai Affiliated Hospital of Binzhou Medical College,Yantai Shandong 264100,China)
出处
《中国急救复苏与灾害医学杂志》
2025年第8期986-990,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
