Tirschwell D L, Longstreth W T, Rauch-Matthews M E, Chandler W L, Rothstein T, Wray L, Eng L J, Fine J, Copass M K
Department of Neurology, School of Public Health and Community Medicine, University of Washington, Seattle 98104-2499, USA.
Neurology. 1997 Feb;48(2):352-7. doi: 10.1212/wnl.48.2.352.
To assess the relationship between CSF creatine kinase BB isoenzyme activity (CSF CKBB) and neurologic outcome after cardiac arrest in clinical practice.
CSF CKBB reflects the extent of brain damage following cardiac arrest.
To help with prognosis, treating physicians ordered CSF CKBB tests on 474 patients over 7.5 years; 351 of these patients had experienced a cardiac arrest. Assays were performed in one laboratory using agarose electrophoresis. By chart review, we determined awakening status for all patients, defined as the patient having comprehensible speech or following commands.
CSF CKBB was usually sampled 48 to 72 hours after cardiac arrest and was strongly associated with awakening (p < < 0.001). The median was 4 U/l for 61 patients who awakened and 191 U/l for 290 who never awakened. For those who awakened, 75% of CKBB levels were < 24 U/l, and for those who never awakened, 75% were > 86 U/l. The highest value in a patient who awakened was 204 U/l, a cutoff that yielded a specificity of 100% of never awakening but a sensitivity of forty-eight percent. Only nine patients who awakened had CSF CKBB values greater than 50 U/l, and none regained independence in activities of daily living. Only three unconscious patients were still alive at last contact, with follow-up of 63, 107, and 109 months. Using logistic regression, the probability of never awakening given a CSF CKBB result can be estimated as: 1/(1 + L), where L = e raised to (0.1267 - 0.0211 x CSF CKBB [U/l]).
CSF CKBB measurement helps to estimate degree of brain damage and thus neurologic prognosis after cardiac arrest. However, results of this retrospective study could reflect in part a self-fulfilling prophecy.
在临床实践中评估脑脊液肌酸激酶BB同工酶活性（CSF CKBB）与心脏骤停后神经功能转归之间的关系。
CSF CKBB反映心脏骤停后脑损伤的程度。
为辅助预后评估，在7.5年期间，治疗医师对474例患者进行了CSF CKBB检测；其中351例患者经历过心脏骤停。检测在一个实验室采用琼脂糖电泳法进行。通过查阅病历，我们确定了所有患者的清醒状态，定义为患者能进行可理解的言语交流或听从指令。
CSF CKBB通常在心脏骤停后48至72小时采集，与清醒状态密切相关（p << 0.001）。61例清醒患者的中位数为4 U/l，290例未清醒患者的中位数为191 U/l。对于清醒患者，75%的CKBB水平< 24 U/l，对于未清醒患者，75%的CKBB水平> 86 U/l。清醒患者中的最高值为204 U/l，该临界值的特异性为100%（即不会清醒），但敏感性为48%。仅有9例清醒患者的CSF CKBB值大于50 U/l，且无一例恢复日常生活活动自理能力。在最后一次随访时，仅有3例昏迷患者仍存活，随访时间分别为63、107和109个月。采用逻辑回归分析，根据CSF CKBB结果估计未清醒的概率为：1/(1 + L)，其中L = e的(0.1267 - 0.0211×CSF CKBB [U/l])次方。
CSF CKBB检测有助于评估心脏骤停后脑损伤程度及神经功能预后。然而，这项回顾性研究的结果可能部分反映了自我实现的预言。
