Yang Ding-Bo, Yu Wen-Hua, Dong Xiao-Qiao, Du Quan, Shen Yong-Feng, Zhang Zu-Yong, Zhu Qiang, Che Zhi-Hao, Liu Qun-Jie, Wang Hao, Jiang Li, Du Yuan-Feng
Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China.
Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, 261 Huansha Road, Hangzhou 310006, China.
Peptides. 2014 Aug;58:26-9. doi: 10.1016/j.peptides.2014.05.015. Epub 2014 Jun 4.
Higher plasma copeptin levels correlate with poor clinical outcomes after traumatic brain injury. Nevertheless, their links with acute traumatic coagulopathy and progressive hemorrhagic injury are unknown. Therefore, we aimed to investigate the relationship between plasma copeptin levels, acute traumatic coagulopathy and progressive hemorrhagic injury in patients with severe traumatic brain injury. We prospectively studied 100 consecutive patients presenting within 6h from head trauma. Progressive hemorrhagic injury was present when the follow-up computerized tomography scan reported any increase in size or number of the hemorrhagic lesion, including newly developed ones. Acute traumatic coagulopathy was defined as an activated partial thromboplastic time greater than 40s and/or international normalized ratio greater than 1.2 and/or a platelet count less than 120×10(9)/L. We measured plasma copeptin levels on admission using an enzyme-linked immunosorbent assay in a blinded fashion. In multivariate logistic regression analysis, plasma copeptin level emerged as an independent predictor of progressive hemorrhagic injury and acute traumatic coagulopathy. Using receiver operating characteristic curves, we calculated areas under the curve for progressive hemorrhagic injury and acute traumatic coagulopathy. The predictive performance of copeptin was similar to that of Glasgow Coma Scale score. However, copeptin did not obviously improve the predictive value of Glasgow Coma Scale score. Thus, copeptin may help in the prediction of progressive hemorrhagic injury and acute traumatic coagulopathy after traumatic brain injury.
血浆 copeptin 水平升高与创伤性脑损伤后的不良临床结局相关。然而，它们与急性创伤性凝血病和进行性出血性损伤之间的联系尚不清楚。因此，我们旨在研究重型创伤性脑损伤患者血浆 copeptin 水平、急性创伤性凝血病和进行性出血性损伤之间的关系。我们前瞻性地研究了 100 例在头部外伤后 6 小时内就诊的连续患者。当随访计算机断层扫描报告出血性病变的大小或数量增加，包括新出现的病变时，存在进行性出血性损伤。急性创伤性凝血病定义为活化部分凝血活酶时间大于 40 秒和/或国际标准化比值大于 1.2 和/或血小板计数小于 120×10⁹/L。我们采用酶联免疫吸附测定法以盲法测量入院时的血浆 copeptin 水平。在多因素逻辑回归分析中，血浆 copeptin 水平成为进行性出血性损伤和急性创伤性凝血病的独立预测因素。使用受试者工作特征曲线，我们计算了进行性出血性损伤和急性创伤性凝血病的曲线下面积。copeptin 的预测性能与格拉斯哥昏迷量表评分相似。然而，copeptin 并未明显提高格拉斯哥昏迷量表评分的预测价值。因此，copeptin 可能有助于预测创伤性脑损伤后的进行性出血性损伤和急性创伤性凝血病。
