Hazuková Radka, Rezácová Martina, Köhlerová Renata, Tomek Tomáš, Cermáková Eva, Kocí Jaromír, Pleskot Miloslav
1st Department of Internal Medicine - Cardioangiology, University Hospital Hradec Králové, Faculty of Medicine in Hradec Králové, Charles University in Prague; Hradec Králové-Czech Republic.
Anatol J Cardiol. 2017 Jul;18(1):31-38. doi: 10.14744/AnatolJCardiol.2017.7578. Epub 2017 Jun 22.
This study aimed to investigate whether out-of-hospital cardiac arrest (OHCA) may induce severe DNA damage measured using comet assay in successfully resuscitated humans and to evaluate a short-term prognostic role.
In this prospective, controlled, blinded study (1/2013-1/2014), 41 patients (age, 63±14 years) successfully resuscitated from non traumatic OHCA and 10 healthy controls (age, 53±17 years) were enrolled. DNA damage [double-strand breaks (DSBs) and single-strand breaks (SSBs)] was measured using comet assay in peripheral lymphocytes sampled at admission. Clinical data were recorded (according to Utstein style). A good short-term prognosis was defined as survival for 30 days.
Among the patients, there were 71% (29/41) short-term survivors. After OHCA, DNA damage (DSBs and SSBs) was higher (11.0±7.6% and 0.79±2.41% in tail) among patients than among controls (1.96±1.63% and 0.02±0.03% in tail), and it was more apparent for DSBs (p<0.001 and p=0.085). There was no difference in the DNA damage between patients with cardiac and non-cardiac etiology, or between survivors and nonsurvivors. Among Utstein style parameters, ventricular fibrillation, asystole, and early electrical defibrillation influenced DSBs; none of the factors influenced SSBs. Factors influencing survival were SSBs, ventricular fibrillation, length of cardiopulmonary resuscitation by professionals ≤15 min, cardiogenic shock, and postanoxic encephalopathy. In contrast to DSBs [area under the curve (AUC)=0.520], SSBs seem to have a potential in prognostication (AUC=0.639).
This study for the first time demonstrates revelation of DNA damage using comet assay in patients successfully resuscitated from OHCA. Whether DNA damage measured using comet assay may be a prognostic marker remains unknown, although our data may encourage some suggestions.
本研究旨在调查院外心脏骤停（OHCA）是否会在成功复苏的患者中导致使用彗星试验测量的严重DNA损伤，并评估其短期预后作用。
在这项前瞻性、对照、盲法研究（2013年1月至2014年1月）中，纳入了41例从非创伤性OHCA中成功复苏的患者（年龄63±14岁）和10名健康对照者（年龄53±17岁）。在入院时采集的外周淋巴细胞中使用彗星试验测量DNA损伤[双链断裂（DSB）和单链断裂（SSB）]。记录临床数据（根据Utstein格式）。良好的短期预后定义为存活30天。
患者中，71%（29/41）为短期幸存者。OHCA后，患者的DNA损伤（DSB和SSB）高于对照组（尾部为11.0±7.6%和0.79±2.41%）（尾部为1.96±1.63%和0.02±0.03%），DSB更为明显（p<0.001和p=0.085）。心脏病因和非心脏病因患者之间、幸存者和非幸存者之间的DNA损伤无差异。在Utstein格式参数中，室颤、心搏停止和早期电除颤影响DSB；这些因素均不影响SSB。影响生存的因素有SSB、室颤、专业人员进行心肺复苏的时间≤15分钟、心源性休克和缺氧后脑病。与DSB[曲线下面积（AUC）=0.520]不同，SSB似乎具有预后潜力（AUC=0.639）。
本研究首次证明在从OHCA成功复苏的患者中使用彗星试验揭示了DNA损伤。尽管我们的数据可能会引发一些建议，但使用彗星试验测量的DNA损伤是否可能是一种预后标志物仍不清楚。
