血清泛素羧基末端水解酶1、脑红蛋白与心肺复苏后昏迷患者神经功能预后的关系研究

Relationship between ubiquitin C-terminal hydrolase-L1,neuroglobinB and neurological prognosis in patients with coma after cardiopulmonary resuscitation

目的探讨血清泛素羧基末端水解酶1(ubiquitin C-terminal hydrolase-L1,UCH-L1)、脑红蛋白浓度与心肺复苏后昏迷患者神经功能预后的关系及预测价值。方法选取2018年2月至2020年6月四川省成都市第三人民医院收治的45例心肺复苏成功后昏迷患者为昏迷组,选取同期收治的62例心肺复苏成功后24 h内意识恢复患者为对照组进行前瞻性研究。入院24 h内均检测血清UCH-L1、脑红蛋白浓度,采用格拉斯哥昏迷(glasgow coma Scale,GCS)和格拉斯哥-匹兹堡脑功能表现分级(cerebral performance category,CPC)评分评估昏迷程度和神经功能预后。Spearman秩相关分析UCH-L1、脑红蛋白浓度与GCS评分、CPC评分相关性。Logistic回归分析影响心肺复苏后昏迷患者神经功能预后的因素,受试者工作特征曲线(receiver operator characteristics curve,ROC)分析UCH-L1、脑红蛋白预测心肺复苏术成功后昏迷患者神经功能预后的价值。结果昏迷组血清UCH-L1[(0.63±0.21) μg/L]、脑红蛋白浓度[(89.34±21.35) mg/L]高于对照组[(0.27±0.08) μg/L,(32.13±9.21) mg/L],差异有统计学意义(t值分别为12.338、18.846;P均<0.001)。UCH-L1、脑红蛋白在轻型、中型、重型昏迷组依次升高,组间比较,差异有统计学意义(F值分别为86.430、26.958;P均<0.001)。神经功能预后不良组血清UCH-L1[(0.72±0.06) μg/L]、脑红蛋白浓度[(100.35±5.79) mg/L]高于神经功能预后良好组[(0.52±0.08) μg/L、(75.58±6.91) mg/L],差异有统计学意义(t值分别为9.585、13.086;P均<0.001)。UCH-L1、脑红蛋白与GCS评分呈负相关(rs=-0.685、-0.669,P均<0.001),与CPC评分均呈正相关(rs=0.688、0.670;P均<0.001)。多因素Logistic回归分析结果显示低GCS评分(OR=0.552,95%CI:0.392~0.776,P<0.001)、高水平UCH-L1(OR=1.881,95%CI:1.276~2.773,P<0.001)和脑红蛋白(OR=1.677,95%CI:1.206~2.331,P=0.001)与心肺复苏后昏迷患者神经功能预后不良独立相关。联合UCH-L1、脑红蛋白预测心肺复苏后昏迷患者神经功能预后不良的AUC为0.954,大于单独UCH-L1、脑红蛋白的0.821、0.790(Z值分别为2.351、2.649,P均<0.05)。结论心肺复苏成功后昏迷患者血清UCH-L1、脑红蛋白浓度均增高,高浓度的UCH-L1、脑红蛋白与昏迷程度加重和神经功能不良有关,可作为神经功能预后评估的潜在生物学指标。

Objective To investigate the relationship between serum ubiquitin C-terminal hydrolase-L1(UCH-L1)and neuroglobin levels and the prognosis of neurological function in coma patients after cardiopulmonary resuscitation,and to analyze their value in predicting the prognosis of patients.Methods From February 2018 to June 2020,45 comatose patients admitted to the Chengdu Third People′s Hospital of Sichuan Province after successful cardiopulmonary resuscitation were prospectively selected as the coma group,and 62 patients admitted to the emergency intensive care unit during the same period after successful cardiopulmonary resuscitation with consciousness recovered within 24 hours were selected as the control group.Serum UCH-L1 and neuroglobin levels were detected within 24 hours after admission.Glasgow coma Scale(GCS)and cerebral performance category(CPC)were used to evaluate coma severity and neurological prognosis.Spearman rank correlation analyzed the correlation between UCH-L1 and neuroglobin levels and GCS and CPC scores.Logistic regression analyzed the factors affecting the prognosis of neurological function in coma patients after cardiopulmonary resuscitation.Receiver operating characteristic curve(ROC)was used to analyze the value of UCH-L1 and neuroglobin in predicting the prognosis of neurological function in coma patients after successful cardiopulmonary resuscitation.Results In coma group,serum UCH-L1((0.63±0.21)μg/L)and the concentration of neuroglobin((89.34±21.35)mg/L)was higher than that in the control group((0.27±0.08)μg/L,(32.13±9.21)mg/L),the difference was statistically significant(t=12.338,18.846;all P<0.001).The levels of UCH-L1 and neuroglobin in mild,medium and severe coma groups were increased in turn,and the differences between the groups were statistically significant(F=86.430,26.958;all P<0.001).The serum levels of UCH-L1((0.72±0.06)μg/L)and neuroglobin((100.35±5.79)mg/L)in the group with poor neurological prognosis were higher than those in the group with good neurological prognosis((0.52±0.08)μg/L,(75.58±6.91)mg/L),and the differences between the groups were statistically significant(t=9.585,13.086;all P<0.001).UCH-L1 and neuroglobin were negatively correlated with GCS score(rs=-0.685,-0.669;all P<0.001),and positively correlated with CPC score(rs=0.688,0.670;all P<0.001).Multivariate Logistic regression analysis showed that low GCS score(OR=0.552,95%CI:0.392-0.776,P<0.001),high UCH-L1(OR=1.881,95%CI:1.276-2.773,P<0.001)and neuroglobin(OR=1.677,95%CI:1.206-2.331,P=0.001)were independently associated with poor neurological outcomes in coma patients after cardiopulmonary resuscitation.The AUC of combining UCH-L1 and neuroglobin in predicting poor neurological outcomes in coma patients after cardiopulmonary resuscitation was 0.954,which was higher than that of UCH-L1 and neuroglobin alone(0.821,0.790)(Z=2.351,2.649;all P<0.05).Conclusion After successful cardiopulmonary resuscitation,the levels of UCH-L1 and neuroglobin in coma patients are increased.High levels of UCH-L1 and neuroglobin are associated with coma severity and neurological dysfunction,which can be used as a potential biological indicator for prognosis evaluation of neurological function.