Department of Intensive Care Medicine and Nephrology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
PLoS One. 2013 Sep 30;8(9):e76720. doi: 10.1371/journal.pone.0076720. eCollection 2013.
Choline is related to phospholipid metabolism and is a marker for global ischaemia with a small reference range in healthy volunteers. The aim of our study was to characterize the early kinetics of plasma free choline in patients after cardiac arrest. Additionally, we investigated the potential of plasma free choline to predict neurological outcome.
Twenty patients admitted to our medical intensive care unit were included in this prospective, observational trial. All patients were enrolled between May 2010 and May 2011. They received post cardiac arrest treatment including mild therapeutic hypothermia which was initiated with a combination of cold fluid and a feedback surface cooling device according to current guidelines. Sixteen blood samples per patient were analysed for plasma free choline levels within the first week after resuscitation. Choline was detected by liquid chromatography-tandem mass spectrometry.
Most patients showed elevated choline levels on admission (median 14.8 µmol/L; interquartile range; IQR 9.9-20.1) which subsequently decreased. 48 hours after cardiac arrest choline levels in all patients reached subnormal levels at a median of 4.0 µmol/L (IQR 3-4.9; p = 0.001). Subsequently, choline levels normalized within seven days. There was no significant difference in choline levels when groups were analyzed in relation to neurological outcome.
Our data indicate a choline deficiency in the early postresucitation phase. This could potentially result in impaired cell membrane recovery. The detailed characterization of the early choline time course may aid in planning of choline supplementation trials. In a limited number of patients, choline was not promising as a biomarker for outcome prediction.
胆碱与磷脂代谢有关，是全身缺血的标志物，在健康志愿者中的参考范围较小。本研究的目的是描述心脏骤停后患者血浆游离胆碱的早期动力学。此外，我们还研究了血浆游离胆碱预测神经功能预后的潜力。
本前瞻性观察性试验纳入了 2010 年 5 月至 2011 年 5 月期间我院重症监护病房收治的 20 例患者。所有患者均接受了心脏骤停后的治疗，包括亚低温治疗，根据目前的指南，采用冷液和反馈表面冷却装置联合治疗。在复苏后第一周内，对每位患者进行了 16 次血浆游离胆碱水平的分析。采用液相色谱-串联质谱法检测胆碱。
大多数患者入院时胆碱水平升高（中位数 14.8 µmol/L；四分位距 IQR 9.9-20.1），随后降低。心脏骤停后 48 小时，所有患者的胆碱水平降至正常值以下，中位数为 4.0 µmol/L（IQR 3-4.9；p=0.001）。随后，7 天内胆碱水平恢复正常。根据神经功能预后分析，胆碱水平在各组之间无显著差异。
我们的数据表明，在复苏后早期存在胆碱缺乏，这可能导致细胞膜恢复受损。早期胆碱时间过程的详细特征可能有助于规划胆碱补充试验。在有限数量的患者中，胆碱作为预后预测的生物标志物并不理想。
