颅脑外伤患者血液中微粒促凝活性的变化

目的 观察颅脑外伤患者血液中微粒促凝活性的时程变化规律,探讨其在脑损伤中的作用及对预后的预测价值.方法 收集中重型颅脑外伤患者139例作为颅脑外伤组;收集同期健康体检人群40例作为对照组.对照组静脉血体检时获得.颅脑外伤组静脉血在入院时及入院后第1、2、3、5和7天获得.利用发色底物法测定血液中微粒促凝活性.结果颅脑外伤患者入院后1个月内死亡50例(36.0%),血液中微粒促凝活性6 h内开始升高,24 h内到达高峰,后逐渐下降,6个时间点血液中微粒促凝活性分别为(10.5±4.3)、(14.7±6.9)、(12.4±5.4)、(10.0±4.6)、(7.8±3.8)、(6.0±3.0)U/ml,经协方差分析,均显著高于对照组(1.7±0.6)U/ml(P<0.001).经多因素分析,血液中微粒促凝活性(OR 1.432,95%CI 1.194～1.719,P<0.01)是颅脑外伤1个月内死亡的危险因素.经重复测量方差分析,死亡组血液中微粒促凝活性显著高于生存组(P=0.01),重型颅脑外伤组血液中微粒促凝活性显著高于中型颅脑外伤组(P=0.002).经Spearman相关分析,血液中微粒促凝活性与入院时GCS评分显著负相关(P<0.05).经多无线性同归分析,血液中微粒促凝活性与入院时血浆C-反应蛋白浓度(P=0.019)和D-二聚体浓度(P=0.012)显著正相关.ROC曲线辨别了血液中微粒促凝活性的预测界值(12.2 U/ml),对预测颅脑外伤1个月内死亡有较高的灵敏度(72.0%)和特异度(85.4%).血液中微粒促凝活性的曲线下面积(0.847±0.037)小于GCS评分(0.917±0.023)的曲线下面积,但差异无统计学意义(P=0.104).结论 颅腩外伤后血液中微粒促凝活性升高,可能参与脑损伤的炎症反应和凝血级联反应,检测这个指标有助于早期判断颅脑外伤患者的预后.

Change in plasma microparticle procoagulant activity after traumatic brain injury

Objective To observe the serial changes of plasma microparticle procoagulant activity in patients with traumatic brain injury (TBI) and evaluate its correlations with outcome and pathophysiology of TBL Methods A total of 139 consecutive patients with isolated moderate or severe head trauma and 40 age-and sex-matched healthy controls were enrolled. Plasma samples were obtained on entry in healthy controls, as well as on admission and at day 1, day 2, day 3, day 5, and day 7 after TBI in the patients. Its concentration was measured by a prothrombinase assay. Results Fifty patients (36. 0% ) died from TBI in a month. After TBI, plasma microparticle procoagulant activity in the patients increased during the 6-hour period immediately, peaked in 24 hours and decreased gradually thereafter. It was substantially higher than that of healthy controls during the 7-day period using analysis of covariate ( P < 0.01 ). A multivariate analysis selected plasma microparticle procoagulant activity ( OR 1.432, 95% CI 1.194-1.719,P <0. 01 ) as an independent predictor for 1-month mortality. Plasma microparticle procoagulant activities of non-survivals were statistically significantly higher than those of survivals ( P = 0. 01 ), and plasma microparticle procoagulant activities of patients with severe TBI were obviously higher than those of patients with moderate TBI (P =0. 002) using repeated-measures analysis. Plasma microparticle procoagulant activities of patients were negatively associated with Glasgow coma scale scores using Spearman correlation coefficient (P < 0. 05). A multivariate linear regression selected plasma D-dimer level (P = 0. 012) and plasma C-creative protein level ( P = 0. 019) related to plasma microparticle procoagulant activities. A receiver operating characteristic curve identified the cutoff levels of plasma microparticle procoagulant activities ( 12.2 U/ml) predicting l-month mortality of patients with the high sensitivity (72.0% ) and specificity values (85.4%). Areas under curve (AUC) of plasma resistin level (AUC =0. 847±0.037) was smaller than those of GCS scores ( AUC = 0. 917±0. 023 ), but this difference failed to reach statistical significance ( P = 0. 104 ). Conclusion Increased activity of plasma microparticle procoagulant is found after traumatic brain injury. It may contribute to inflammatory reaction and coagulation cascade and is associated with a poor clinical outcome.