Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Department of Neurological Surgery, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Sci Rep. 2022 Nov 9;12(1):19107. doi: 10.1038/s41598-022-23912-4.
Traumatic brain injury (TBI) is associated with coagulation/fibrinolysis disorders. We retrospectively evaluated 61 TBI cases transported to hospital within 1 h post-injury. Levels of thrombin-antithrombin III complex (TAT), D-dimer, and plasminogen activator inhibitor-1 (PAI-1) were measured on arrival and 3 h, 6 h, 12 h, 1 day, 3 days and 7 days after injury. Multivariate logistic regression analysis was performed to identify prognostic factors for coagulation and fibrinolysis. Plasma TAT levels peaked at admission and decreased until 1 day after injury. Plasma D-dimer levels increased, peaking up to 3 h after injury, and decreasing up to 3 days after injury. Plasma PAI-1 levels increased up to 3 h after injury, the upward trend continuing until 6 h after injury, followed by a decrease until 3 days after injury. TAT, D-dimer, and PAI-1 were elevated in the acute phase of TBI in cases with poor outcome. Multivariate logistic regression analysis showed that D-dimer elevation from admission to 3 h after injury and PAI-1 elevation from 6 h to 1 day after injury were significant negative prognostic indicators. Post-TBI hypercoagulation, fibrinolysis, and fibrinolysis shutdown were activated consecutively. Hyperfibrinolysis immediately after injury and subsequent fibrinolysis shutdown were associated with poor outcome.
创伤性脑损伤（TBI）与凝血/纤溶障碍有关。我们回顾性评估了 61 例创伤后 1 小时内送往医院的 TBI 病例。在入院时以及受伤后 3 小时、6 小时、12 小时、1 天、3 天和 7 天时测量了凝血酶-抗凝血酶 III 复合物（TAT）、D-二聚体和纤溶酶原激活物抑制剂-1（PAI-1）的水平。进行多变量逻辑回归分析以确定凝血和纤溶的预后因素。血浆 TAT 水平在入院时达到峰值，并在受伤后 1 天内下降。血浆 D-二聚体水平升高，在受伤后 3 小时达到峰值，并在受伤后 3 天内下降。血浆 PAI-1 水平在受伤后 3 小时内升高，上升趋势持续到受伤后 6 小时，随后下降到受伤后 3 天。TAT、D-二聚体和 PAI-1 在 TBI 急性期升高，与不良预后相关。多变量逻辑回归分析表明，从入院到受伤后 3 小时 D-二聚体升高和从受伤后 6 小时到 1 天 PAI-1 升高是显著的负预后指标。TBI 后高凝、纤溶和纤溶失活相继激活。受伤后立即发生的过度纤溶和随后的纤溶失活与不良预后有关。
