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J Korean Soc Emerg Med > Volume 21(2); 2010 > Article
Journal of The Korean Society of Emergency Medicine 2010;21(2): 147-155.
The Expression of Cytochrome c, TNF-R1 and Fas Ligand in Patient's Serum after Successful Cardiopulmonary Resuscitation
Byung Hak So, Chun Song Youn, Si Kyoung Jeong, Seung Pill Choi, Hyung Min Kim, Kyu Nam Park
Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. emsky@catholic.ac.kr
Numerous reports have suggested that apoptosis may play an important role in postresuscitation syndrome. The aim of this study is to assess the levels of molecules that are associated with apoptosis in the serum of patients who underwent successful resuscitation after cardiac arrest.
The serum levels of cytochrome c, tumor necrosis factor type 1 receptor (TNF-R1) and Fas ligand in 11 patients were measured at 0, 4, 12, 24, 48 and 72 hours after successful resuscitation. The primary endpoint consisted of survival to hospital discharge. Ten healthy volunteers were also evaluated as a control group.
Patients with successful resuscitation had increased levels of cytochrome c and TNF-R1 at 0, 4, 12, 24 and 48 hours after return of spontaneous circulation (ROSC), as compared with those levels of the healthy volunteers (p<0.05). Higher levels of TNF-R1 at 12, 24 and 48 hours after ROSC were found in the non-survivors as compared to those levels of the survivors (p=0.01, 0.03, 0.02). The Fas ligand level at ROSC was also higher in the patients with successful resuscitation (p=0.00). However, the Fas ligand levels at 24, 48 and 72 hours after ROSC were lower in the patients with successful resuscitation than those levels in the healthy volunteers.
These results suggest that apoptosis belonging to the TNF-R1 and cytochrome c pathways may be involved in the pathogenesis of postresuscitation syndrome. The serum levels of the death-receptor TNF-R1 could serve to quantitate the severity of injury and to prognosticate the survival outcomes.
Key words: Apoptosis, Cardiopulmonary resuscitation, Cytochrome c, Tumor necrosis factor receptor type 1, Fas ligand protein
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