[单纯钝性颅脑损伤患者的凝血因子 VII 活性：与凝血病及进行性出血性损伤的关联]
[Activity of factor VII in patients with isolated blunt traumatic brain injury: association with coagulopathy and progressive hemorrhagic injury].
作者信息
Li Chaoyue, Pei Bingbing, Wu Xing, Lu Xin, Hu Jin, Zhou Liangfu
机构信息
Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou 450003, China. Email:
Department of Neurosurgery, Shanghai Huashan Hospital, Fudan University. Email:
出版信息
Zhonghua Yi Xue Za Zhi. 2014 Mar 11;94(9):688-91.
OBJECTIVE
To explore the relationship of the activity of plasma FVII with isolated blunt traumatic brain injury and progressive hemorrhagic injury.
METHODS
Eight-one isolated traumatic brain patients with moderate-to-severe injury, aged ≥ 16 yrs, were recruited from August 2010 to December 2012. The plasma factor VII activity was measured after admission. On arrival at emergency department, blood samples were collected to analyze the parameters of activated partial thromboplastic time (aPTT), international normalized ratio (INR), platelet count and activity of factor VII. TBI-associated coagulopathy was defined as elevated international normalized ratio >1.2 or prolonged activated partial thromboplastic time >40 seconds or platelet count <120×10(9)/L at admission. Progressive hemorrhagic injury was present when follow-up computed tomography (CT) noted any increase in size or number of hemorrhagic lesions. Logistic regression examined the risks for coagulopathy and progressive hemorrhagic injury after isolated traumatic brain injury.
RESULTS
FVII activity in patients with coagulopathy was 86% ± 35%. And it was significantly lower than those without coagulopathy (100 ± 29%, P < 0.05). Isolated traumatic brain injury patients with FVII activity <77.5% had an odds ratio for coagulopathy of 5.52 (95% confidence interval 1.82-16.68, P < 0.05) relative to those with FVII activity ≥ 77.5%. FVII activity in patients with progressive hemorrhagic injury was 71% ± 18%. And it was significantly lower than those without progressive hemorrhagic injury (106% ± 32%, P < 0.001). Stepwise Logistic regression analysis identified FVII < 77.5% as a predisposing risk factor independently associated with the presence of progressive hemorrhagic injury. The overall mortality rate in the surveyed population was 7.4% (6/81). The plasma FVII in deceased patients (91% ± 47%) was slightly lower than that in survivors (92% ± 32%, P > 0.05). No significant difference existed between two groups (P > 0.05).
CONCLUSIONS
Decreased activity of FVII is closely correlated with coagulopathy in patients with isolated blunt traumatic brain injury. And coagulopathy and decreased FVII activity are predisposing risk factors independently associated with progressive hemorrhagic injury.
目的
探讨血浆FVII活性与单纯钝性颅脑损伤及进行性出血性损伤之间的关系。
方法
选取2010年8月至2012年12月收治的81例年龄≥16岁的中重度单纯性颅脑损伤患者。入院后测定血浆凝血因子VII活性。到达急诊科时，采集血样分析活化部分凝血活酶时间（aPTT）、国际标准化比值（INR）、血小板计数及凝血因子VII活性等参数。创伤性脑损伤相关凝血病定义为入院时国际标准化比值>1.2或活化部分凝血活酶时间>40秒或血小板计数<120×10⁹/L。当随访计算机断层扫描（CT）显示出血性病变的大小或数量增加时，则存在进行性出血性损伤。采用Logistic回归分析单纯性颅脑损伤后凝血病和进行性出血性损伤的风险。
结果
凝血病患者的FVII活性为86%±35%，显著低于无凝血病患者（100±29%，P<0.05）。FVII活性<77.5%的单纯性颅脑损伤患者发生凝血病的比值比为5.52（95%置信区间1.82-16.68，P<0.05），而FVII活性≥77.5%的患者则无此情况。发生进行性出血性损伤患者的FVII活性为71%±18%，显著低于无进行性出血性损伤患者（106%±32%，P<0.001）。逐步Logistic回归分析确定FVII<77.5%是与进行性出血性损伤独立相关的易感危险因素。调查人群的总死亡率为7.4%（6/81）。死亡患者的血浆FVII（91%±47%）略低于存活患者（92%±32%，P>0.05）。两组间无显著差异（P>0.05）。
结论
单纯钝性颅脑损伤患者中FVII活性降低与凝血病密切相关。凝血病和FVII活性降低是与进行性出血性损伤独立相关的易感危险因素。
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