Miao Wang, Zhao Ke, Deng Wenjing, Teng Junfang
First Affiliated Hospital of Zhengzhou University, Department of Neurology, Zhengzhou, People's Republic of China.
First Affiliated Hospital of Zhengzhou University, Department of Neurology, Zhengzhou, People's Republic of China.
World Neurosurg. 2018 Feb;110:e46-e52. doi: 10.1016/j.wneu.2017.09.200. Epub 2017 Nov 28.
To explore the change of coagulation function and associated potential mechanisms and the relationship between coagulation disorders and deep venous thrombosis (DVT) after subarachnoid hemorrhage (SAH) within 3 days of onset.
A total of 150 patients with SAH within 3 days of onset and 100 healthy individuals were recruited. Thrombelastography analysis and traditional laboratory tests were performed. Tissue factor (TF), tissue factor pathway inhibitor (TFPI) and activated protein C (APC) were tested by using enzyme-linked immunoassay kits. Extremities of patients with SAH were scanned by Doppler ultrasonography. Subgroup analysis was performed in patients with SAH based on the presence or lack of DVT.
Compared with control groups, R (an indicator of coagulation factor function in thrombelastography) was significantly decreased (4.32 ± 0.99 minutes vs. 6.00 ± 0.75 minutes; P < 0.001), especially in patients with DVT. TF was significantly increased (20.84 ± 4.15 pg/mL vs. 5.24 ± 1.86 pg/mL; P < 0.001). TFPI was decreased (50.42 ± 5.81 ng/mL vs. 64.10 ± 6.04 ng/mL). APC had no apparent changes. R was negatively correlated with TF (r = 0.358; P < 0.05) and positively correlated with TFPI (r = 0.325; P < 0.05) and APC (r = 0.162; P < 0.05). TF, TFPI, and APC had the same variation characteristics in the DVT subgroup compared with the no DVT subgroup. DVT was associated with R through association analysis (r = 0.369; P < 0.05). The R cutoff value for estimating the presence of DVT was 3.65 minutes.
Coagulation factor hyperfunction may be mainly accompanied within 3 days of SAH onset and may induce DVT. This situation may be associated with TF-TFPI-APC imbalance. R = 3.65 minutes was a potential intervention point to prevent the risk of DVT in this population.
探讨蛛网膜下腔出血（SAH）发病3天内凝血功能的变化及其相关潜在机制，以及凝血功能障碍与深静脉血栓形成（DVT）之间的关系。
招募150例发病3天内的SAH患者和100名健康个体。进行血栓弹力图分析和传统实验室检查。使用酶联免疫分析试剂盒检测组织因子（TF）、组织因子途径抑制剂（TFPI）和活化蛋白C（APC）。对SAH患者的四肢进行多普勒超声扫描。根据是否存在DVT对SAH患者进行亚组分析。
与对照组相比，R（血栓弹力图中凝血因子功能指标）显著降低（4.32±0.99分钟 vs. 6.00±0.75分钟；P<0.001），尤其是在DVT患者中。TF显著升高（20.84±4.15 pg/mL vs. 5.24±1.86 pg/mL；P<0.001）。TFPI降低（50.42±5.81 ng/mL vs. 64.10±6.04 ng/mL）。APC无明显变化。R与TF呈负相关（r = 0.358；P<0.05），与TFPI呈正相关（r = 0.325；P<0.05），与APC呈正相关（r = 0.162；P<0.05）。与无DVT亚组相比，DVT亚组中TF、TFPI和APC具有相同的变化特征。通过关联分析，DVT与R相关（r = 0.369；P<0.05）。估计DVT存在的R临界值为3.65分钟。
SAH发病3天内可能主要伴有凝血因子功能亢进，并可能诱发DVT。这种情况可能与TF-TFPI-APC失衡有关。R = 3.65分钟是预防该人群DVT风险的潜在干预点。
