Kanaya Takahiro, Nakae Ryuta, Sekine Tetsuro, Fujiki Yu, Takayama Yasuhiro, Igarashi Yutaka, Suzuki Go, Naoe Yasutaka, Yokota Hiroyuki, Yokobori Shoji
Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
Acta Neurochir (Wien). 2025 Mar 25;167(1):90. doi: 10.1007/s00701-025-06496-6.
In its acute phase, traumatic brain injury (TBI) is notable for disturbances in the coagulation/fibrinolysis system. Plasmin, alpha 2-plasmin inhibitor (α2-PI), and their complex (plasmin-α2-PI complex [PIC]) are important components of the coagulation-fibrinolytic system, but their time courses in the acute phase of TBI and their association with long-term prognosis are unknown.
We conducted a retrospective analysis of 84 consecutive patients with isolated TBI, during which plasma α2-PI and PIC levels were measured at the time of arrival, as well as at 3, 6, and 12 h, and on days 1, 3, and 7 post-injury. Differences in plasma α2-PI and PIC levels between the good outcome group (extended Glasgow Outcome Scale [GOS-E] of 5-8 at 6 months post-injury) and the poor outcome group (GOS-E of 1-4 at 6 months post-injury) were analyzed using a generalized linear mixed model (GLMM). The hematoma volume of the initial CT scan upon admission and the follow-up CT scan was evaluated using CT volumetry, and then the relationship between changes in hematoma volume and plasma levels of α2-PI and PIC at admission was examined.
Abnormally high plasma PIC levels were observed at admission in 97.6% of the patients. In the GLMM adjusted for covariates, the poor outcome group had significantly lower plasma α2-PI activity from admission to 3 days post-injury and significantly higher plasma PIC levels from admission to 6 h post-injury compared to the good outcome group. A negative correlation was found between α2-PI activity at admission and changes in hematoma volume (Spearman's correlation coefficient, r = - 0.587, p = 0.001).
These findings suggest that plasmin was activated and fibrinolysis enhanced immediately after injury in most patients, while in a subset of patients, hematoma expansion due to the suppression of fibrinolytic inhibition by α2-PI negatively affected the outcome.
在急性期，创伤性脑损伤（TBI）以凝血/纤维蛋白溶解系统紊乱为显著特征。纤溶酶、α2-纤溶酶抑制剂（α2-PI）及其复合物（纤溶酶-α2-PI复合物[PIC]）是凝血-纤维蛋白溶解系统的重要组成部分，但它们在TBI急性期的时间进程及其与长期预后的关系尚不清楚。
我们对84例连续的孤立性TBI患者进行了回顾性分析，在此期间，在患者入院时、伤后3、6和12小时以及伤后第1、3和7天测量血浆α2-PI和PIC水平。使用广义线性混合模型（GLMM）分析预后良好组（伤后6个月扩展格拉斯哥预后量表[GOS-E]评分为5-8）和预后不良组（伤后6个月GOS-E评分为1-4）之间血浆α2-PI和PIC水平的差异。使用CT容积测量法评估入院时及随访CT扫描时初始CT扫描的血肿体积，然后检查入院时血肿体积变化与血浆α2-PI和PIC水平之间的关系。
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