Yokota Hiroyuki, Atsumi Takahiro, Araki Takashi, Fuse Akira, Sato Hidetaka, Kushimoto Shigeki, Koido Yuichi, Kawai Makoto, Yamamoto Yasuhiro
Department of Emergency and Critical Care Medicine, Main Hospital, Nippon Medical School, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2007 Sep;47(9):383-8; discussion 388. doi: 10.2176/nmc.47.383.
Elevated serum levels of thrombomodulin (TM) and von Willebrand factor (vWf) are good indicators of injury and activation of cerebral endothelium in patients with severe simple head injury. The present study evaluated cerebral endothelial injury or activation as the serum levels of TM and vWf in elderly and younger patients with similar brain trauma, to evaluate the primary parenchymal injury of the brain. Patients with head injury were classified into the young group (16-30 years), the middle-aged group (31-65 years), and the elderly group (over 66 years). There was no difference in Glasgow Coma Scale on admission between the three groups. The serum levels of TM and vWf at 2 hours after injury were significantly higher in the elderly group than in the other groups. However, the serum levels of TM and vWf were not significantly different at 3 and 7 days after injury. Cerebral endothelial activation and injury were significantly higher in elderly patients just after head injury than in younger patients, which suggests that greater sensitivity to endothelial injury and activation may be important in the worse outcome after head injury in elderly patients compared with younger patients.
血清中血栓调节蛋白（TM）和血管性血友病因子（vWf）水平升高是重度单纯性颅脑损伤患者脑内皮损伤和激活的良好指标。本研究通过评估年龄较大和较年轻的、有相似脑外伤的患者血清TM和vWf水平来评价脑内皮损伤或激活情况，以评估脑实质的原发性损伤。颅脑损伤患者被分为青年组（16 - 30岁）、中年组（31 - 65岁）和老年组（66岁以上）。三组患者入院时格拉斯哥昏迷量表评分无差异。老年组伤后2小时血清TM和vWf水平显著高于其他组。然而，伤后3天和7天血清TM和vWf水平无显著差异。老年患者伤后即刻脑内皮激活和损伤明显高于年轻患者，这表明与年轻患者相比，老年患者对内皮损伤和激活更敏感可能是其颅脑损伤后预后较差的重要原因。
