rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2023-6-13-24rmt-2404Research ArticleПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTIONERПрогноз выхода из вегетативного состоянияPrognosis for Recovery from a Vegetative StateВайншенкерЮ. И.VainshenkerYu. I.

Юлия Исааковна Вайншенкер

197376, г. Санкт-Петербург, ул. акад. Павлова, д. 12

Yulia I. Vainshenker

12 Akad. Pavlov Str., 197376, Saint Petersburg

juliavajn@mail.ruЦыганН. В.TsyganN. V.

194044, г. Санкт-Петербург, ул. Академика Лебедева, д. 6

188300, Ленинградская обл., г. Гатчина, мкр. Орлова роща, д. 1

123182, г. Москва, пл. Академика Курчатова, д. 1

Nikolay V. Tsygan

6 Akad. Lebedev Str., 194044 Saint Petersburg

1 Orlova roshcha mkr., 188300 Gatchina, Leningrad region

1 Akad. Kurchatova Sq., 123182 Moscow

ОдинакМ. М.OdinakM. M.

194044, г. Санкт-Петербург, ул. Академика Лебедева, д. 6

Miroslav M. Odinak

6 Akad. Lebedev Str., 194044 Saint Petersburg

ЛитвиненкоИ. В.LitvinenkoI. V.

194044, г. Санкт-Петербург, ул. Академика Лебедева, д. 6

Igor V. Litvinenko

6 Akad. Lebedev Str., 194044 Saint Petersburg

Институт экспериментальной медициныРоссияInstitute of experimental medicineRussian FederationВоенно-медицинская академия им. С. М. Кирова; Петербургский институт ядерной физики им. Б. П. Константинова Национального исследовательского центра «Курчатовский институт»; Национальный исследовательский центр «Курчатовский институт»РоссияKirov Military Medical Academy; Konstantinov St. Petersburg Institute for Nuclear Physics, National Research Center «Kurchatov Institute»; National Research Center «Kurchatov Institute»Russian FederationВоенно-медицинская академия им. С. М. КироваРоссияKirov Military Medical AcademyRussian Federation2023211220231961324Copyright © Вайншенкер Ю.И., Цыган Н.В., Одинак М.М., Литвиненко И.В., 20232023Вайншенкер Ю.И., Цыган Н.В., Одинак М.М., Литвиненко И.В.Vainshenker Y.I., Tsygan N.V., Odinak M.M., Litvinenko I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2404Цель

Цель. Установить значимость прогноза выхода из ВС, сформированного при клиническом сопоставлении данных ПЭТ с 18 фтордезоксиглюкозой (ПЭТ18-ФДГ) и МРТ (СКТ).

Материалы и методы

Материалы и методы. Ретроспективно, в сплошной выборке из 39 больных, находившихся в ВС разной этиологии более 2 мес. от времени повреждения мозга (из них в хроническом ВС — 18 человек), анализировали результаты сопоставления данных ПЭТ и МРТ (СКТ) головного мозга, а также ряда других прогностических критериев и катамнеза через 6 мес. — 7 лет (CRS-R). Использовали попарное сравнение групп (уровень значимости p0,05) и, дополнительно, множественное сравнение для трех групп (поправка Бонферрони для трех групп, p0,017).

Результаты

Результаты. Выделили три варианта нейровизуализационных сопоставлений: I — площадь функциональных нарушений превышала структурные, II — полное совпадение нарушений, III — смешанный. Вариант I (69% случаев) встречали чаще, чем II (18%), и чем III (13%), p0,001. Различий по этиологии, срокам ВС, баллам CRS-R, полу и возрасту пациентов, распределенных по вариантам этих сопоставлений, не установили. Исход при I варианте (все вышли из ВС) был лучше, чем при II и III вариантах, p0,001, а при III — лучше, чем при II (все остались в ВС), p=0,018. В целом прирост общего балла CRS-R составил при варианте I — 12,1±4,46 (4–19, [Me=12], n=27), при II — 0±1,54 (–2–1, [0], n=7), при III — 5,20±4,09 (1–10, [4], n=5). При варианте I улучшение было более выраженным у пациентов с нехроническим ВС, чем с хроническим ВС, p=0,003.

Заключение

Заключение. Клиническое сопоставление ПЭТ/МРТ (СКТ)-данных показало возможность прогнозировать выход из ВС в 87% случаев. Подтвержденный ретроспективно благоприятный прогноз (вариант I) составил 69%, неблагоприятный (вариант II) — 18%, причем независимо от других прогностических критериев, включая хроническое ВС. Это подтверждает правильность нейрофизиологического обоснования и целесообразность практического применения предлагаемого способа прогнозирования.

The prognosis for recovery from a vegetative state (VS) remains underdeveloped.

Objective

Objective. To determine the feasibility of prognosis for recovery from a vegetative state based on clinical comparison of 18- fluorodeoxyglucose-PET (18FDGPET) and MRI (SCT) data.

Materials and methods

Materials and methods. We compared and analyzed retrospectively cerebral PET and MRI (SCT) scans and relevant prognostic criteria (including revised coma recovery scale — CRS-R scores) prospectively during 6–84 months of follow-up in a cohort of 39 VS patients. All VS cases were of different etiologies, lasting for more than 2 months after brain damage (including 18 patients in chronic VS).

Pairwise comparison of groups was used (significance level P0.05) and multiple comparison for three groups with a Bonferroni correction at P0.017 was employed.

Results

Results. Three patterns were identified when comparing 18FDGPET and MRI (SCT) neuro-images: pattern I — the area of functional alterations was larger than the area of structural damage, pattern II — complete matching of areas of structural and functional alterations, III — mixed pattern. Pattern I (69% of cases) was more common than patterns II (18%), and III (13%), P0.001. There were no differences in VS etiology, VC duration, CRS-R scores, patients’ gender and age between the groups of patients each falling into one of patterns. The outcome in a group with pattern I patients (all of them recovered from VS) was better than in other two groups exhibiting patterns II or III, each, P0.001. In a group of patients with pattern III the recovery was better than in pattern II (all patients remained in VS), P=0.018. The increases in the total CRS-R score values were as follows: 12,1±4,46; Me=12 (4–19), N=27 (patients with a pattern I); 0±1,54 (–2–1, Me=0, N=7 (patients with a pattern II); and 5,20±4,09/ Me=4 (1 — 10), N=5 (patients with a pattern III). Significant increases in neurological improvement were revealed in pattern I patients with non-chronic VS versus chronic VS, P=0.003.

Conclusion

Conclusion. Clinical comparison of PET/MRI (SCT) data showed certain potential to predict patient’s recovery from VS in 87% of cases. A retrospectively confirmed favorable prognosis in patients with pattern I was established in 69% cases, unfavorable (pattern II patients) was defined in 18% cases, regardless of other prognostic criteria, including chronic VS. Therefore, the data confirms the feasibility and clinical relevance of neurophysiological justification as a candidate approach for evaluating the prospect of recovering patients from VS.

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The authors declare that there are no conflicts of interest present.