摘要
目的通过对心肺复苏(CPR)患者血浆核转录因子kappa B(NF-κB)亚基p65、肿瘤坏死因子α(TNF-α)及核因子E2相关因子2(Nrf2)的相关性分析,研究NF-кB与Nrf2/ARE信号通路的关联性,并分析其对预后的影响。方法收集2015年7月—2017年7月杭州师范大学附属医院急诊科存活超过72 h的CPR患者,分别于心脏骤停(CA)时、自主循环恢复(ROSC)即刻、ROSC后2、8、12、24、48、72 h八个时间点采集其外周血,测定血浆中NF-κB亚基p65、TNF-α及Nrf2水平,观察其动态变化,并进行相关性分析,最后采用ROC曲线分析判断其对预后的影响。结果 100例CPR成功患者,36例存活超过72 h。Nrf2在CPR后出现不同程度的降低,在ROSC后8 h达到最低谷,而NF-κB亚基p65、TNF-α在CPR后均明显增高,分别在ROSC后12 h、8 h达到最高峰。Nrf2与NF-κB亚基p65、TNF-α呈负相关关系(r分别为-0.505、-0.446,P<0.05)。NF-κB亚基p65与TNF-α呈正相关关系(r=0.531,P<0.05)。ROC曲线分析提示NF-κB亚基p65、TNF-α可预测CPR患者预后的严重程度。结论 CA患者CPR后出现不同程度的炎症反应和氧化应激损伤,两者关系密切,互相影响,且炎症反应对预后的影响明显大于氧化应激损伤。
Objective To investigate the relevance between NF-κB signal pathway and Nuclear factor erythroid 2-related factor 2(Nrf2)/ARE signal pathway through analyzing the correlation among NF-κB p65, TNF-α and Nrf2 levels in cardiac arrest(CA) patients undergoing cardiopulmonary resuscitation(CPR). Methods Medical records of CA patients undergoing CPR and survived more than 72 hours were collected, the plasma levels of NF-κB p65, TNF-α and Nrf2 were tested at CA, return of spontaneous circulation(ROSC) and 2, 8, 12, 24, 48, 72 h after ROSC, their changes and correlations were analyzed. Furtherly, the factors affecting prognosis of CPR were analyzed by ROC curve. Results Total 36 patients survived more than 72 hours in 100 CA patients undergoing CPR and had ROSC. The plasma level of Nrf2 decreased to varying degrees, and dropped to the lowest level at 8 h after ROSC. However, the plasma levels of NF-κB p65 and TNF-α increased significantly, and peaked at 12 h and 8 h after ROSC respectively. Correlation analysis showed that Nrf2 was negatively correlated with NF-κB p65 and TNF-α(r=-0.505,-0.446, P<0.05), NF-κB p65 was positively correlated with TNF-α(r=0.531, P<0.05). ROC curve showed that NF-κB p65 and TNF-α could predict the prognosis of patients with CPR. Conclusion The inflammation and oxidative stress injury will occurred in CA patients undergoing CPR, they are closely related and affected each other. The effect of inflammation on prognosis is significantly greater than oxidative stress injury.
作者
夏金明
赖登攀
魏霞
吕世进
XIA Jin-ming;LAI Deng-pan;WEI Xia(Department of Emergency,the Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang 310015,China)
出处
《中华全科医学》
2019年第3期374-378,共5页
Chinese Journal of General Practice
基金
浙江省医药卫生一般研究计划项目(2015KYB300)
关键词
心肺复苏
炎症反应
氧化应激
核因子E2相关因子2
Cardiopulmonary resuscitation
Inflammatory response
Oxidative stress
Nuclear factor erythroid 2-related factor 2
