Ulusoy Emel, Duman Murat, Çağlar Aykut, Küme Tuncay, Er Anıl, Akgül Fatma, Çitlenbik Hale, Yılmaz Durgül, Ören Hale
Dokuz Eylül University Faculty of Medicine, Department of Pediatric Emergency Care, İzmir, Turkey.
Dokuz Eylül University Faculty of Medicine, Department of Biochemistry, İzmir, Turkey.
Turk J Haematol. 2018 May 25;35(2):122-128. doi: 10.4274/tjh.2017.0444. Epub 2018 Mar 28.
Acute traumatic coagulopathy occurs after trauma with impairment of hemostasis and activation of fibrinolysis. Some endogenous substances may play roles in this failure of the coagulation system. Extracellular histone is one such molecule that has recently attracted attention. This study investigated the association between plasma histone-complexed DNA (hcDNA) fragments and coagulation abnormalities in pediatric trauma patients.
This prospective case-control study was conducted in pediatric patients with trauma. Fifty trauma patients and 30 healthy controls were enrolled. Demographic data, anatomic injury characteristics, coagulation parameters, computerized tomography findings, trauma, and International Society on Thrombosis and Haemostasis disseminated intravascular coagulation (ISTH DIC) scores were recorded. Blood samples for hcDNA were collected and assessed by enzyme-linked immunosorbent assay.
Thirty-two patients had multiple trauma, while 18 patients had isolated brain injury. hcDNA levels were significantly higher in trauma patients than healthy controls (0.474 AU and 0.145 AU, respectively). There was an association between plasma hcDNA levels and trauma severity. Thirteen patients had acute coagulopathy of trauma shock (ACoTS). ACoTS patients had higher plasma histone levels than those without ACoTS (0.703 AU and 0.398 AU, respectively). Plasma hcDNA levels were positively correlated with the ISTH DIC score and length of stay in the intensive care unit and were negatively correlated with fibrinogen level.
This study indicated that hcDNA levels were increased in pediatric trauma patients and associated with the early phase of coagulopathy. Further studies are needed to clarify the role of hcDNA levels in mortality and disseminated intravascular coagulation.
急性创伤性凝血病发生于创伤后，伴有止血功能受损和纤溶激活。一些内源性物质可能在凝血系统的这种功能障碍中起作用。细胞外组蛋白就是这样一种最近引起关注的分子。本研究调查了小儿创伤患者血浆组蛋白复合DNA（hcDNA）片段与凝血异常之间的关联。
本前瞻性病例对照研究在小儿创伤患者中进行。纳入了50例创伤患者和30例健康对照。记录人口统计学数据、解剖损伤特征、凝血参数、计算机断层扫描结果、创伤及国际血栓与止血学会弥散性血管内凝血（ISTH DIC）评分。采集用于检测hcDNA的血样，并通过酶联免疫吸附测定法进行评估。
32例患者有多发伤，18例患者有单纯脑损伤。创伤患者的hcDNA水平显著高于健康对照（分别为0.474 AU和0.145 AU）。血浆hcDNA水平与创伤严重程度之间存在关联。13例患者发生创伤性休克急性凝血病（ACoTS）。ACoTS患者的血浆组蛋白水平高于无ACoTS的患者（分别为0.703 AU和0.398 AU）。血浆hcDNA水平与ISTH DIC评分及重症监护病房住院时间呈正相关，与纤维蛋白原水平呈负相关。
本研究表明，小儿创伤患者的hcDNA水平升高，且与凝血病的早期阶段相关。需要进一步研究以阐明hcDNA水平在死亡率和弥散性血管内凝血中的作用。
