CAJ | 학술논문

目的研究单纯创伤性脑损伤(TBI)患者早期血浆凝血因子Ⅶ(FⅦ)的变化,分析其与进展性颅内出血(PHI)的相关性,为治疗PHI提供依据. 方法选取2010年8月-2014年6月收治的年龄≥16岁的中、重度单纯TBI患者112例,分别采集患者入院时、入院后24 h、48 h外周静脉血标本检测国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、血小板、D-二聚体、纤维蛋白蛋(FIB)及FⅦ活性.每24h随访患者头颅CT 1次,当再次CT扫描较首次CT扫描显示的出血性病灶扩大或有新出现的出血性病灶则诊断为PHI,否则为非PHI. 结果 PHI患者入院时、入院后24,48 h血浆FⅦ活性均显著低于非PHI患者[入院时,(77.79±22.82)％∶(100.32±30.39)％]、[入院后24h,(95.25 ±28.20)％∶(113.52±21.66)％]、[入院后48 h,(93.02±21.34)％:(107.69±20.26)％] (P ＜0.05);PHI组患者入院时、24h、48 h血小板水平同样显著低于非PHI组患者[入院时,(126.95±48.46):(148.13±53.41)]、[入院后24h,(108.79±42.88):(129.53±48.22)]、[入院后48 h,(101.45±41.91):(128.44±51.52)] (P ＜0.05).PHI患者伤后48 h内血浆APTT、INR、D-二聚体、FIB均高于非PHI患者,但两组间差异无统计学意义(P＞0.05).Logistic回归分析结果显示,FⅦ活性降低和血小板水平降低是单纯TBI患者发生PHI的独立危险因素(P＜0.05). 结论单纯TBI早期FⅦ活性降低和血小板水平降低与PHI密切相关,对指导治疗PHI具有重要意义.
목적 연구단순창상성뇌손상(TBI)환자조기혈장응혈인자Ⅶ(FⅦ)적변화,분석기여진전성로내출혈(PHI)적상관성,위치료PHI제공의거. 방법 선취2010년8월-2014년6월수치적년령≥16세적중、중도단순TBI환자112례,분별채집환자입원시、입원후24 h、48 h외주정맥혈표본검측국제표준화비치(INR)、활화부분응혈활매시간(APTT)、혈소판、D-이취체、섬유단백단(FIB)급FⅦ활성.매24h수방환자두로CT 1차,당재차CT소묘교수차CT소묘현시적출혈성병조확대혹유신출현적출혈성병조칙진단위PHI,부칙위비PHI. 결과 PHI환자입원시、입원후24,48 h혈장FⅦ활성균현저저우비PHI환자[입원시,(77.79±22.82)％∶(100.32±30.39)％]、[입원후24h,(95.25 ±28.20)％∶(113.52±21.66)％]、[입원후48 h,(93.02±21.34)％:(107.69±20.26)％] (P ＜0.05);PHI조환자입원시、24h、48 h혈소판수평동양현저저우비PHI조환자[입원시,(126.95±48.46):(148.13±53.41)]、[입원후24h,(108.79±42.88):(129.53±48.22)]、[입원후48 h,(101.45±41.91):(128.44±51.52)] (P ＜0.05).PHI환자상후48 h내혈장APTT、INR、D-이취체、FIB균고우비PHI환자,단량조간차이무통계학의의(P＞0.05).Logistic회귀분석결과현시,FⅦ활성강저화혈소판수평강저시단순TBI환자발생PHI적독립위험인소(P＜0.05). 결론 단순TBI조기FⅦ활성강저화혈소판수평강저여PHI밀절상관,대지도치료PHI구유중요의의.
Objective To measure the early changes of plasma coagulation factor Ⅶ (FⅦ) in patients with traumatic brain injury (TBI) and analyze the association between F Ⅶ and progressive hemorrhagic injury (PHI) so as to provide evidences for treatment of PHI.Methods The study enrolled 112 patients with moderate or severe isolated TBI,aged ≥ 16 years,who were admitted to the neurotrauma center at Shanghai Huashan Hospital from August 2010 through June 2014.Peripheral blood samples were collected at admission,24 hours and 48 hours after admission to determine the parameters of international normalized ratio (INR),activated partial thromboplastin time (APTT),platelet count (PLT),D-dimer,fibrinogen (FIB) and FⅦ activity.Follow-up head CT was performed every 24 hours.PHI was defined as when follow-up CT noted any increase in size or number of hemorrhagic lesions.Results Plasma level of FⅦ in patients who developed PHI were significantly lower than those without PHI [0 hour:(77.79 ± 22.82)％ vs (100.32 ±30.39)％;24 hours:(95.25 ±28.20)％ vs (113.52 ± 21.66) ％;48 hours:(93.02 ± 21.34) ％ vs (107.69 ± 20.26) ％,P ＜ 0.05].Platelet level in patients with PHI were significantly lower than those with PHI [0 hour:(126.95 ± 48.46) vs (148.13 ± 53.41);24 hours:(108.79 ±42.88) vs (129.53 ±48.22);48 hours:(101.45 ±41.91) vs (128.44 ±51.52),P ＜ 0.05].Plasma levels of APTT,INR,D-dimer,and FIB in patients with PHI increased compared to those without PHI,but the differences were insignificant (P ＞ 0.05).Logistic regression analysis identified decreases in F Ⅶ level and platelet count as independent risk factors for the presence of PHI (P ＜ 0.05).Conclusion At early stage after TBI,the decreased F Ⅶ activity and the low platelet level are closely associated with PHI,indicating their importance in guiding treatment of PHI.