Effects of NF-κB p65 and TNF-α on Nrf2/ARE signal pathway in patients undergoing cardiopulmonary resuscitation

Objective To investigate the relevance between NF-κB signal pathway and Nuclear factor erythroid 2-related factor 2 (Nrf2) /ARE signal pathway through analyzing the correlation among NF-κB p65, TNF-α and Nrf2 levels in cardiac arrest (CA) patients undergoing cardiopulmonary resuscitation (CPR). Methods Medical records of CA patients undergoing CPR and survived more than 72 hours were collected, the plasma levels of NF-κB p65, TNF-α and Nrf2 were tested at CA, return of spontaneous circulation (ROSC) and 2, 8, 12, 24, 48, 72 h after ROSC, their changes and correlations were analyzed. Furtherly, the factors affecting prognosis of CPR were analyzed by ROC curve. Results Total 36 patients survived more than 72 hours in 100 CA patients undergoing CPR and had ROSC. The plasma level of Nrf2 decreased to varying degrees, and dropped to the lowest level at 8 h after ROSC. However, the plasma levels of NF-κB p65 and TNF-α increased significantly, and peaked at 12 h and 8 h after ROSC respectively. Correlation analysis showed that Nrf2 was negatively correlated with NF-κB p65 and TNF-α (r=-0.505, -0.446, P<0.05), NF-κB p65 was positively correlated with TNF-α (r=0.531, P<0.05). ROC curve showed that NF-κB p65 and TNF-α could predict the prognosis of patients with CPR. Conclusion The inflammation and oxidative stress injury will occurred in CA patients undergoing CPR, they are closely related and affected each other. The effect of inflammation on prognosis is significantly greater than oxidative stress injury.