Correlation Between MIP-1?, UCH-l1 Changes And Hypothalamic-pituitary-thyroid Function Changes In Patients With Cardiopulmonary Resuscitation

Objective:To investigate the relationship between MIP-1?,UCH-L1 and hypothalamicpituitary-thyroid function changes in patients with cardiopulmonary resuscitation.Methods:Patients with cardio pulmonary resuscitation(CPR)return of spontaneous circulation(ROSC)were given 3 mL of peripheral venous blood in sterile tubes at immediate,6 hours,12 hours,and 24 hours,and serum was extracted after high-speed centrifugation.Store in a low temperature refrigerator at-20 °C,and then take the same blood collection treatment as above.The enzyme macrophage inflammatory protein-1 alpha(MIP-1 ?)was detected by enzyme-linked immunosorbent assay(ELISA).,ubiquitin carboxyl-terminal hydrolase-L1(UCH-L1),triiodothyronine(T3),thyroxine(T4),free thyroxine(Free thyroxine,FT4),free triiodothyronine(FT3),thyrotropin(TSH)concentration,antithyroid peroxidase antibody(TPOAb),antithyroglobulin antibody(antithyroglobulin antibody,TGAb),record data,and compare serum concentration changes and clinical prognosis at the same time period Conditions.According to the final effect of resuscitation,the patients were divided into poor prognosis group(40 cases): spontaneous circulation was restored and the establishment time was >24h,but eventually died.The prognosis group(10 cases): successful resuscitation,15 days of survival or discharge.Inclusion criteria:(1)Collection of emergency department and ICU of the First Affiliated Hospital of Jiamusi University.Cardiac arrest(CA)occurred in the hospital from August 2017 to June 2018.Patients who recovered spontaneous circulation after cardiopulmonary resuscitation 50 cases were registered in Utstein mode;(2)According to the 2015 International Cardiopulmonary Resuscitation and Cardiovascular Emergency Guidelines,the criteria for cardiac arrest were: 1 loss of consciousness 2 no spontaneous breathing,no normal breathing(only wheezing)3 major arteries The pulsation disappeared.4 The electrocardiogram showed ventricular fibrillation,no pulse electrical activity,and whole heart arrest.(3)The patient's family signed the informed consent form.Exclusion criteria:(1)had a history of thyroid disease,recently took drugs that affect thyroid function;(2)age: <16 years old;(3)unable to judge CA time;(4)cases with incomplete trauma and medical records.Cardiopulmonary resuscitation method: chest compression,artificial respiration,etc.according to the standard “ cardiopulmonary resuscitation and cardiovascular first aid guidelines of 2015” in China,some patients are supplemented with ventilator,and continuous vital signs monitoring,routine application Adrenaline 1 mg was intravenously administered,and ineffective was administered once every 3-5 minutes,and patients with ventricular fibrillation were given shock defibrillation.Patients with shock were given norepinephrine boost.When ventricular fibrillation(VF)or pulsed ventricular tachycardia(PVT)CPR patients with defibrillation and booster therapy are not considered to use amiodarone;conventional treatment of ventricular fibrillation(VF)or pulseless ventricular tachycardia Magnesium is not recommended for adult patients at high speed(PVT).The criteria for successful cardiopulmonary resuscitation:(1)touching the aorta pulsation,hearing heart sounds,blood pressure can be detected;(2)the heart can maintain blood pressure ? 90/60 mmHg or mean arterial pressure ? 60 mmHg under autonomous rhythm or pacing rhythm;(3)The pupil is changed from large to small,and there is light reflection or eye movement;(4)face,lips,nail bed,skin turns rosy;(5)ECG waveform has improved.The above situation is maintained for more than 24 hours as the criteria for successful recovery.The main contents of the Utstein model record are:(1)general patient data: gender,age,past history;(2)cardiac arrest data: time of cardiac arrest,location of cardiac arrest,whether to witness cardiac arrest,whether to implement bystander The cardiopulmonary resuscitation,the cause of cardiac arrest,the first monitoring of heart rhythm is defibrillation rhythm,cardiac arrest to cardiopulmonary resuscitation start-up time,adrenaline use dose;(3)resuscitation results 24 h survival,survival and discharge.Results:(1)P>0.05 between the two groups after MIP-1?,UCH-L1,TPOAb,TGAb,FT3,FT4,T3,T4,TSH and CH.There was no significant difference between the two groups.(2)MIP-1?,UCH-L1,TSH,TGAb,TPOAb index: The prognosis group at 6 hours,12 hours,and 24 hours after CPR was significantly higher than the poor prognosis group(P<0.05),which was statistically significant;3)FT3,FT4,T3,T4 indicators: 6 hours,12 hours,24 hours after CPR,the prognosis was significantly lower than the poor prognosis group(P<0.05),statistically significant;(4)MIP-1? and UCH-L1 was positively correlated;TGAb,TPOAb,TSH were positively correlated with MIP-1? and UCH-L1;T3,T4,FT3,FT4 were negatively correlated with MIP-1?;FT3 and FT4 were negatively correlated with UCH-L1,T3,There was no correlation between T4 and UCH-L1(r=--0.144,-0.274,P>0.05).Conclusion:(1)The serum concentrations of MIP-1? and UCH-L1 in patients with cardiopulmonary resuscitation were significantly increased.MIP-1? decreased after 12 hours and remained at a high concentration.The more significant the increase,the worse the prognosis.(2)Patients with cardiopulmonary resuscitation have different degrees of brain damage and hypothalamic-pituitary-thyroid axis dysfunction,which may be manifested as non-thyroid disease syndrome.(3)In patients with cardiopulmonary resuscitation,there is a correlation between MIP-1? and UCH-L1 and hypothalamic-pituitary-thyroid axis.Early monitoring of changes in serum concentrations of MIP-1? and UCH-L1 is important for assessing the degree of brain injury and prognosis.value.