重型颅脑损伤患者去骨瓣减压联合天幕裂孔切开术后检测t-PA、PAI－1的临床意义

目的探讨血清、脑脊液中t-PA、PA1－1的测定在重型颅脑损伤患者行去骨瓣减压联合天幕裂孔切开术后的临床意义。方法采用酶联免疫吸附双抗体夹心法测定、比较50例重型颅脑损伤患者去骨瓣减压联合天幕裂孔切开术后24h、3d、1周、2周、3周及50例轻型颅脑损伤患者血清、脑脊液的t—PA、PAI-1水平。结果重型颅脑损伤组脑脊液及血清t-PA、PAI．1在各期均明显高于对照组（P〈0．01）。GCS（3～5分）组瞄脊液及血清中此两项指标在伤后各阶段明显高于GCS（6～8分）组，两组差异有统计学意义（P〈0．01）。重型颅脑损伤预后良好组（n=28例）脑脊液及血清t—PA、PAI-1伤后各阶段均明显低于预后恶劣组（n=22例），两组差异有统计学意义（P〈0．05）。结论重型颅脑损伤后t-PA、PAI-1的变化可以反映脑实质损伤的严重程度，同时与预后呈负相关。通过临床上对重型颅脑损伤患者脑脊液及血清t-PA、PAI-1的检测．可以评估患者病情的严重程度及预后。

Clinical Study of Determination of t-PA and PAI-1 in Severe Craniocerebral Injury Patients Treated by Decompressive Craniotomy with Removal of Open Asparamide Hiatus

Objective To study the changes in tissue plasminogen activator （t-PA） and plasminogen activator inhibitor-1 （ PAI-1 ） in senlm and cerebrospinal fluid of patients with severe craniocerebral injury treated by decompressive craniotomy with cutting open asparamide hiatus and their clinical significance. Methods Enzyme linked immunosorbent assay （ILISA） was utilized to determine t-PA and PAI-1 in the serum and the cerebrospinal fluid of 50 patients with severe craniocerebral injury treated by decompressive craniotomy with removal of open asparamide hiatus. Another 50 mild patients were enrolled in as controls. Results The con- centrations of t-PA and PAI-1 in the serum and the cerebrospinal fluid in trial group were significantly higher than that in the control group （ P 〈 0.01 ） at all the stages. Each index was higher in the group with a GCS of 3 - 5 than in the group with a GCS of 6 - 8 （ P 〈 0.01 ）. The concentrations of t-PA and PAI-1 in the group with good prognosis were significantly lower than that in the groul： with bad prognosis （ P 〈0.05）. Conclusion The changes in t-PA and PAI-1 in patients with severe craniocerebral injury, which arc negatively correlative with the Drognosis. reflect the disease condition.