早期纤维蛋白溶解与创伤性脑损伤后的出血进展有关。

Early Fibrinolysis Associated with Hemorrhagic Progression Following Traumatic Brain Injury.

机构信息

*Department of Surgery, Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas †Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas ‡Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.

出版信息

Shock. 2017 Dec;48(6):644-650. doi: 10.1097/SHK.0000000000000912.

DOI:10.1097/SHK.0000000000000912

PMID:28614144

Abstract

BACKGROUND

Progressive hemorrhagic injury (PHI) is common in patients with severe traumatic brain injury (TBI) and is associated with worse outcomes. PHI pathophysiology remains poorly understood and difficult to predict. We performed an exploratory analysis aimed at identifying markers in need of further investigation to establish their predictive value in PHI following TBI.

METHODS

We performed a retrospective chart review of prospectively collected data from 424 highest-level activation trauma patients from January 2012 through December 2013. Patients with severe TBI, defined as head acute injury scale (AIS) score ≥3 and intracranial hemorrhage (ICH) on initial CT, were included. Stable hemorrhage (SH) and PHI was determined by measuring ICH expansion on repeat CT within 6 h. Of 424 patients evaluated, 72 met inclusion criteria. Twenty-five patients had repeated samples available and were dichotomized into SH (n = 6, 24%) and PHI (n = 19, 76%). Levels of plasminogen, urokinase and tissue plasminogen activators (uPA, tPA), plasminogen activator inhibitor-1, α2-antiplasmin (α2AP), and D-Dimers (DD) were measured upon admission and 2, 4, and 6 h later.

RESULTS

Longitudinal models identified tPA and DD as positively associated and α2AP inversely associated with PHI. High DD levels are strongly associated with developing PHI over time. Using the full TBI cohort of N = 72, receiver operating curve analysis provided a cutoff of 3.04 μg/mL admission DD to distinguish SH from PHI patients.

CONCLUSION

Our findings support a relationship between markers of fibrinolysis in polytrauma patients with severe TBI and PHI, warranting further investigation into the potential for novel, predictive biomarkers.

摘要

背景

进展性出血性损伤（PHI）在严重创伤性脑损伤（TBI）患者中很常见，与更差的预后相关。PHI 的病理生理学仍知之甚少，难以预测。我们进行了一项探索性分析，旨在确定需要进一步研究的标志物，以确定其在 TBI 后 PHI 中的预测价值。

方法

我们对 2012 年 1 月至 2013 年 12 月期间 424 名最高级别的激活性创伤患者前瞻性收集的数据进行了回顾性图表审查。纳入标准为头部急性损伤评分（AIS）≥3 分且初始 CT 显示颅内出血（ICH）的严重 TBI 患者。通过在 6 小时内重复 CT 测量 ICH 扩张来确定稳定出血（SH）和 PHI。在评估的 424 名患者中，有 72 名符合纳入标准。25 名患者有重复样本可供分析，分为 SH（n=6，24%）和 PHI（n=19，76%）。入院时以及 2、4 和 6 小时后测量纤溶酶原、尿激酶和组织纤溶酶原激活物（uPA、tPA）、纤溶酶原激活物抑制剂-1、α2-抗纤溶酶（α2AP）和 D-二聚体（DD）水平。