摘要
目的探讨心脏骤停(CA)患者复苏后早期血清糖萼标志物水平和患者预后的关系。方法本研究是一项回顾性队列研究。以徐州医科大学附属医院2021年9月至2022年10月发生CA后恢复自主循环(ROSC)超过24 h并且入住重症监护病房的患者为研究对象,收集CA后第24小时的血清用以检测血清糖萼标志物水平,包括硫酸乙酰肝素(HS)、透明质酸(HA)和黏结蛋白聚糖-1(Sdc-1)。按照CA后30 d的脑功能分级(CPC)将患者分为功能良好组(CPC=1~2)和功能不良组(CPC=3~5),以logistic回归分析血清糖萼标志物和神经功能预后的关系。以30 d生存结局重新将患者分组,即存活组和死亡组,以Cox回归分析血清糖萼标志物和患者30 d死亡率之间的关系。结果共纳入71例患者,其中女31例(43.7%),男40例(56.3%);年龄(59.0±17.0)岁。与功能良好组(n=22)相比,功能不良组(n=49)HS和HA水平均更高[HS:2461.0(1623.0,5492.0)μg/L比1492.0(914.0,2550.0)μg/L,P=0.008;HA:124.0(97.0,365.0)μg/L比337.0(135.0,1421.0)μg/L,P=0.033];校正的logistic回归分析发现,高HS水平是CA患者30 d神经功能预后不良的危险因素(OR=0.389,95%CI:0.182~0.828,P=0.014)。在30 d生存分析中,和生存组(n=39)相比,死亡组(n=32)的HS和HA水平要明显增高[HS:1880.0(1011.0,3554.0)μg/L比2500.0(1726.0,6276.0)μg/L,P=0.027;HA:162.0(99.0,537.0)μg/L比813.0(148.0,1531.0)μg/L,P=0.025];校正的Cox回归表明高HS和HA均是30 d死亡的危险因素(HS:HR=1.697,95%CI:1.126~2.557,P=0.011;HA:HR=1.336,95%CI:1.047~1.705,P=0.020)。结论CA后24 h血清HS可能用于预测30 d神经功能和死亡率;HA可能仅用于预测30 d死亡率;而Sdc-1对预后无预测作用。
Objective To assess the levels of serum glycocalyx markers in the first 24 hours after cardiac arrest(CA)and investigate their relationship with 30-day outcomes.Methods A retrospective cohort study was conducted on prospectively collected data from CA patients,who were admitted to the intensive care units of the Affiliated Hospital of Xuzhou Medical University and obtained return of spontaneous circulation for more than 24 hours between September 2021 and October 2022.Serum samples obtained at the 24-hour after CA were utilized to measure the levels of glycocalyx markers,including heparan sulfate(HS),hyaluronic acid(HA),and syndecan-1(Sdc-1).Patients were allocated into good function(CPC1-2)and poor function(CPC3-5)groups on the basis of cerebral performance category(CPC)at 30 days post-CA.Logistic regression analysis was used to determine the association between serum glycocalyx markers and neurological outcomes.Patients were regrouped in light of 30-d mortality and Cox regression analysis was used to determine the association between serum glycocalyx markers and 30-d mortality.Results A total of 71 patients were included in the study,including 31(43.7%)females and 40(56.3%)males,with an average age of(59.0±17.0)years.The poor function group(n=49)demonstrated significantly elevated levels of HS and HA when compared to the good function group(n=22)[HS:2461.0(1623.0,5492.0)μg/L vs 1492.0(914.0,2550.0)μg/L,P=0.008;HA:124.0(97.0,365.0)μg/L vs 337.0(135.0,1421.0)μg/L,P=0.033].Adjusted logistic regression analysis revealed that HS was independently associated with poor neurological outcome[odds ratio(OR)=0.389,95%confidence interval(CI):0.182-0.828,P=0.014].In the 30-day mortality analysis,the death group(n=32)exhibited significantly higher levels of HS and HA when compared to the survival group(n=39)[HS:1880.0(1011.0,3554.0)μg/L vs 2500.0(1726.0,6276.0)μg/L,P=0.027;HA:162.0(99.0,537.0)μg/L vs 813.0(148.0,1531.0)μg/L,P=0.025].Adjusted Cox regression analysis indicated that elevated levels of HS and HA were independent risk factors(HS:HR=1.697,95%CI:1.126-2.557,P=0.011;HA:HR=1.336,95%CI:1.047-1.705,P=0.020)for 30-day mortality.Conclusions High level of serum HS in 24 hours after CA may serve as a potential predictive marker for both neurological function and 30-day mortality.However,high level of serum HA appears to primarily predict 30-day mortality.Sdc-1 does not seem to contribute to outcome prediction.
作者
贺丹
苏成磊
薛婷
王吉慧
陈可
赵宁军
胡书群
花嵘
许铁
燕宪亮
He Dan;Su Chenglei;Xue Ting;Wang Jihui;Chen Ke;Zhao Ningjun;Hu Shuqun;Hua Rong;Xu Tie;Yan Xianliang(Emergency Medicine Department,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第1期63-68,共6页
National Medical Journal of China
基金
国家自然科学基金(82202426)
江苏省自然科学基金(BK20220674)
徐州市青年医学科技创新项目(XWKYHT20210571)
睿E(睿意)急诊医学研究专项基金(R2021003)
作者简介
通信作者:燕宪亮,Email:docyxl@163.com
