Huang Man, Cai Hua-bo, Hu Yue-yu, Dong Xiao-qiao
Department of Intensive Care Unit, Sir Run Run Shaw Hospital, Hangzhou 310016, China.
Zhonghua Yi Xue Za Zhi. 2009 Aug 25;89(32):2265-8.
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 TBI.
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.
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 1-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).
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.
观察创伤性脑损伤（TBI）患者血浆微粒促凝活性的系列变化，并评估其与TBI患者预后及病理生理学的相关性。
连续纳入139例孤立性中度或重度颅脑外伤患者及40例年龄、性别匹配的健康对照者。健康对照者于入组时采集血浆样本，TBI患者于入院时、伤后第1天、第2天、第3天、第5天和第7天采集血浆样本。采用凝血酶原酶测定法测量其浓度。
50例（36.0%）患者在1个月内死于TBI。TBI后，患者血浆微粒促凝活性在伤后即刻6小时内升高，24小时达峰值，此后逐渐下降。采用协方差分析，在7天观察期内其水平显著高于健康对照者（P<0.01）。多因素分析选择血浆微粒促凝活性（OR 1.432，95%CI 1.194-1.719，P<0.01）作为1个月死亡率的独立预测指标。采用重复测量分析，未存活者的血浆微粒促凝活性显著高于存活者（P=0.01），重度TBI患者的血浆微粒促凝活性明显高于中度TBI患者（P=0.002）。采用Spearman相关系数分析，患者血浆微粒促凝活性与格拉斯哥昏迷量表评分呈负相关（P<0.05）。多因素线性回归分析选择与血浆微粒促凝活性相关的血浆D-二聚体水平（P=0.012）和血浆C反应蛋白水平（P=0.019）。受试者工作特征曲线确定血浆微粒促凝活性的截断值为12.2 U/ml，预测患者1个月死亡率的敏感度为72.0%，特异度为85.4%。血浆抵抗素水平的曲线下面积（AUC=0.847±0.037）小于格拉斯哥昏迷量表评分的曲线下面积（AUC=0.917±0.023），但差异无统计学意义（P=0.104）。
创伤性脑损伤后血浆微粒促凝活性升高。其可能参与炎症反应和凝血级联反应，并与不良临床预后相关。
