Bidari Ali, Vaziri Samira, Moazen Zadeh Ehsan, Farahmand Sahar, Talachian Elham
Department of Emergency Medicine, Hazrat-e-Rasoul Akram Medical Centre, Iran University of Medical Sciences, Tehran, Iran.
Department of Emergency Medicine, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Emerg (Tehran). 2015 Summer;3(3):89-94.
N-methyl-D-aspartate receptor subunits antibody (NR2-ab) is a sensitive marker of ischemic brain damage in clinical circumstances, such as cerebrovascular accidents. We aimed to assess the value of serum NR2-ab in predicting the post-cardiopulmonary resuscitation (CPR) survival.
In this cohort study, we examined serum NR2-ab levels 1 hour after the return of spontaneous circulation (ROSC) in 49 successfully resuscitated patients. Patients with traumatic or asphyxic arrests, prior neurological insults, or major medical illnesses were excluded. Participants were followed until death or hospital discharge. Demographic data, coronary artery disease risk factors, time before initiation of CPR, and CPR duration were documented. In addition, Glasgow coma scale (GCS), blood pressure, and survival status of patients were recorded at 1, 6, 24, and 72 hour(s) after ROSC. Descriptive analyses were performed, and the Cox proportional hazard model was applied to assess if NR2-ab level is an independent predictive factor of survival.
49 successfully resuscitated patients were evaluated; 27 (55%) survived to hospital discharge, 4 (8.1%) were in vegetative state, 10 (20.4%) were physically disabled, and 13 (26.5%) were physically functional. Within 72 hours of ROSC all of the 12 NR2-ab positive patients died. In contrast, 31 (84%) of the NR2-ab negative patients survived. Sensitivity, specificity, positive and negative likelihood ratios of NR2-ab in prediction of survival were 54.5% (95%CI=32.7%-74.9%), 100% (95%CI=84.5%-100%), infinite, and 45.5% (95%CI=28.8%-71.8%), respectively. Subsequent analysis showed that both NR2-ab status and GCS were independent risk factors of death.
A positive NR2-ab serum test 1 hour after ROSC correlated with lower 72-hour survival. Further studies are required to validate this finding and demonstrate the value of a quantitative NR2-ab assay and its optimal time of measurement.
N-甲基-D-天冬氨酸受体亚基抗体（NR2-ab）是临床情况下缺血性脑损伤的敏感标志物，如脑血管意外。我们旨在评估血清NR2-ab在预测心肺复苏（CPR）后存活情况中的价值。
在这项队列研究中，我们检测了49例成功复苏患者自主循环恢复（ROSC）后1小时的血清NR2-ab水平。排除有创伤性或窒息性心脏骤停、既往神经损伤或重大内科疾病的患者。对参与者进行随访直至死亡或出院。记录人口统计学数据、冠状动脉疾病危险因素、开始CPR前的时间以及CPR持续时间。此外，在ROSC后1、6、24和72小时记录患者的格拉斯哥昏迷量表（GCS）、血压和存活状态。进行描述性分析，并应用Cox比例风险模型评估NR2-ab水平是否为存活的独立预测因素。
对49例成功复苏的患者进行了评估；27例（55%）存活至出院，4例（8.1%）处于植物状态，10例（20.4%）身体残疾，13例（26.5%）身体功能正常。在ROSC后72小时内，12例NR2-ab阳性患者全部死亡。相比之下，NR2-ab阴性患者中有31例（84%）存活。NR2-ab预测存活的敏感性、特异性、阳性和阴性似然比分别为54.5%（95%CI=32.7%-74.9%）、100%（95%CI=84.5%-100%）、无穷大、45.5%（95%CI=28.8%-71.8%）。后续分析表明，NR2-ab状态和GCS均为死亡的独立危险因素。
ROSC后1小时血清NR2-ab检测呈阳性与72小时生存率较低相关。需要进一步研究来验证这一发现，并证明定量NR2-ab检测的价值及其最佳检测时间。
