심폐소생술 후 순환회복 되어 저체온 요법을 시행한 환자에서 신경학적 예후에 따른 혈청 Interleukin-6와 Interleukin-10의 발현 양상 = The Serial Changes of the Serum Interleukin-6 and Interleukin-10 Concentrations in Patients who Received Therapeutic Hypothermia after Successful Cardiopulmonary Resuscitation

다국어 초록 (Multilingual Abstract)

Purpose: We wanted to investigate the serial changes of
the serum interleukin-6 (IL-6) and interleukin-10 (IL-10) concentrations,
according to the neurological outcome, in
patients who received therapeutic hypothermia after successful
cardiopulmonary resuscitation. We also wanted to
evaluate the usefulness of serum IL-6 and IL-10 as biochemical
markers to predict the neurological outcome.
Methods: We prospectively evaluated 23 patients who
received therapeutic hypothermia after successful cardiopulmonary
resuscitation. Blood samples were taken at 0,
4, 12, 24 and 48 hours after the return of spontaneous circulation.
We compared the IL-6 and IL-10 levels between
the good (CPC 1 to 2) and poor (CPC 3 to 5) neurological
outcome (NO) groups.
Results: The serum IL-6 level at 0 hr was significantly higher
in the good NO group than that in the poor NO group.
The periods of time that showed the greatest pattern of
change between the good and poor NO groups were 4-12
hr for the IL-6 level and 0-4 hr for the IL-10 level. On the
analysis of the ROC curve, the cut-off value for delta IL-10
(0-4 hr) was -5.4 pg/ml (AUC=0.827, sensitivity 80.0%,
specificity 93.3%, p=0.032) and the cut-off value for delta
IL-6 (4-12 hr) was 62.8 ng/ml (AUC=0.527, sensitivity
80.0%, specificity 34.0%, p=0.861, respectively).
Conclusion: Our study suggests that the early delta IL-10
can be used as a neurological prognostic marker for
patients who are undergoing therapeutic hypothermia after
successful cardiopulmonary resuscitation.

참고문헌 (Reference)

1 이운정, "심정지후 저산소성-허혈성 뇌병증에서 뇌척수액 Cytokine 농도의 변화" 대한응급의학회 14 (14): 494-499, 2003

2 Bernard SA, "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia" 346 : 557-563, 2002

3 Adrie C, "Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome" 106 : 562-568, 2002

4 Mussack T, "Serum S-100B and interleukin-8 as predictive markers for comparative neurologic outcome analysis of patients after cardiac arrest and severe traumatic brain injury" 30 : 2669-2674, 2002

5 Schmitt KR, "S100B modulates IL-6 release and cytotoxicity from hypothermic brain cells and inhibits hypothermiainduced axonal outgrowth" 59 : 68-73, 2007

6 Negovsky VA, "Post-resuscitation disease: a new nosological entity: its reality and significance" 30 : 23-27, 1995

7 Park KN, "Pattern of serum interleukin-6 concentration after initial successful cardioulmonary rsuscitation" 9 : 571-577, 1998

8 Hypothermia after Cardiac Arrest Study Group, "Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest" 346 : 549-556, 2002

9 Harukuni I, "Mechanism of brain injury after global cerebral ischemia" 24 : 1-21, 2006

10 Vila N, "Levels of anti-inflammatory cytokines and neurological worsening in acute ischemic stroke" 34 : 671-675, 2003

11 Swartz KR, "Interleukin-6 promotes post-traumatic healing in the central nervous system" 896 : 86-95, 2001

12 Strle K, "Interleukin-10 in the brain" 21 : 427-449, 2001

13 Keun Woo Park, "Interleukin-10 endogenously expressed in microglia preventslipopolysaccharide-induced neurodegeneration in the ratcerebral cortex in vivo" 생화학분자생물학회 39 (39): 812-819, 2007

14 Sotgiua S, "Inflammatory biomarkers in blood of patients with acute brain ischemia" 13 : 505-513, 2006

15 Bernard S, "Induced hypothermia in intensive care medicine" 24 : 382-388, 1996

16 Waje-Andreassen U, "IL-6: an early marker for outcome in acute ischemic stroke" 111 : 360-365, 2005

17 Holzer M, "Hypothermia for neuroprotection after cardiac arrest: systemic review and individual patient data meta-analysis" 33 : 414-418, 2005

18 Callaway CW, "Hypothermia after cardiac arrest does not alter serum inflammatory markers" 36 : 2607-2612, 2008

19 White BC, "Global brain ischemia and reperfusion" 27 : 588-594, 1996

20 Heper Y, "Evaluation of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, and interleukin-10 levels as diagnostic and prognostic parameters in patients with community acquired sepsis, severe sepsis, and septic shock" 25 : 481-491, 2006

21 Taniguchi T, "Effects of hypothermia on mortality and inflammatory responses to endotoxin-induced shock in rats" 10 : 940-943, 2003

22 Busto R, "Effect of mild hypothermia on ischemiainduced release of neurotransmitters and free fatty acids in rat brain" 20 : 904-910, 1989

23 Choi SP, "Correlation between brain ischemia-reperfusion injury and tumor necrosis factor-alpha following cardiac arrest in rats" 10 : 531-540, 1999

24 Hong NK, "Changes of interleukin-10 level in patients undergoing cardiopulmonary bypass" 33 : 648-654, 2000

25 Penkowa M, "Astrocyte-targeted expression of IL-6 protects the CNS against a focal brain injury" 181 : 130-148, 2003

26 Tedgui A, "Anti-inflammatory mechanisms in the vascular wall" 88 : 877-887, 2001

27 Rothwell NJ, "Annual review prize lecture cytokines: killers in the brain?" 514 : 3-17, 1999

28 Morimoto Y, "Acute brain swelling after out-of-hospital cardiac arrest: pathogenesis and outcome" 21 : 104-110, 1993

29 ECC Committee, Subcommittes and Task Forces fo the American Heart Association, "2005 American Heart Association (AHA) guideline for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC): part 7.5. postresuscitation support" 112 (112): IV84-IV88, 2005

30 ECC Committee, Subcommittes and Task Forces of the American Heart Associaton, "2005 American Heart Association (AHA) guideline for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC)" 112 (112): IV1-IV203, 2005