摘要
目的探讨血清组织型纤溶酶原激活抑制复合物(t-PAIC)、血栓调节蛋白(TM)对重型颅脑损伤(sTBI)患者急性创伤性凝血病(ATC)的预测价值。方法选取2021年1月至2024年1月濮阳市人民医院重症医学科收治的120例sTBI患者作为研究对象(研究组),根据是否出现ATC将研究组分为非ATC组(n=89)和ATC组(n=31),另选取同期体检的健康者100例作为对照组。采用酶联免疫吸附法测定并比较研究组和对照组、非ATC组和ATC组的血清t-PAIC、TM。采用受试者工作特性(ROC)曲线分析血清t-PAIC、TM对sTBI患者发生ATC的预测价值;采用多因素Logistic逐步回归分析sTBI患者发生ATC的影响因素。结果研究组患者血清t-PAIC、TM明显高于对照组,差异均有统计学意义(P<0.05)。ATC组sTBI患者血清t-PAIC、TM明显高于非ATC组sTBI患者,差异均有统计学意义(P<0.05)。血清t-PAIC、TM预测sTBI患者发生ATC的AUC分别为0.793(95%CI:0.743~0.838)、0.846(95%CI:0.796~0.891),两者联合预测的AUC为0.908(95%CI:0.863~0.958)。单因素结果显示,ATC组患者入院GCS评分、动脉血pH明显低于非ATC组,休克、蛛网膜下腔出血比例明显高于非ATC组,差异均有统计学意义(P<0.05)。多因素Logistic分析显示,入院GCS评分≤4.68分(OR=2.261,95%CI:1.405~3.641)、动脉血pH≤6.04(OR=2.098,95%CI:1.248~3.527)、t-PAIC≥21.48 ng/mL(OR=2.826,95%CI:1.808~4.419)、TM≥27.41 TU/mL(OR=2.575,95%CI:1.637~4.050)是sTBI患者发生ATC的独立危险因素(P<0.05)。结论sTBI患者发生ATC与血清t-PAIC、TM升高密切相关,血清t-PAIC、TM对sTBI患者发生ATC具有一定的预测价值,且两者联合检测的预测效能更佳。
Objective To explore the predictive value of serum tissue plasminogen activator inhibitory complex(t-PAIC)and thrombomodulin(TM)for acute traumatic coagulopathy(ATC)in patients with severe traumatic brain injury(sTBI).Methods A total of 120 patients with sTBI from January 2021 to January 2024 were selected(study group).According to the presence or absence of ATC,the study group was divided into non-ATC group(n=89)and ATC group(n=31),and another 100 healthy people were selected as the control group.Enzyme-linked immunosorbent assay was used to measure and compare the serum t-PAIC and TM between the study group and the control group,non-ATC group and ATC group.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum t-PAIC and TM for ATC in patients with sTBI.The influencing factors of ATC in patients with sTBI were explored by multivariate Logistic stepwise regression analysis.Results The levels of t-PAIC and TM in the study group were higher than the control group(P<0.05).The levels of t-PAIC and TM in sTBI patients in ATC group were higher than those in sTBI patients in nonATC group(all P<0.05).The AUC of serum t-PAIC and TM in predicting ATC in sTBI patients was 0.793(95%CI:0.743-0.838),0.846(95%CI:0.796-0.891),and the AUC of the combination of the two was 0.908(95%CI:0.863-0.958).Univariate results showed that the GCS score and arterial blood pH of patients in ATC group were significantly lower than those in non-ATC group,and the proportion of patients with shock and subarachnoid hemorrhage was significantly higher than that in non-ATC group(all P<0.05).Multivariate analysis showed that GCS score at admission 4.68(OR=2.261,95%CI:1.405-3.641),arterial pH≤6.04(OR=2.098,95%CI:1.248-3.527),t-PAIC≥21.48 ng/mL(OR=2.826,95%CI:1.808-4.419),TM≥27.41 TU/mL(OR=2.575,95%CI:1.637-4.050)were the independent risk factors for ATC in sTBI patients(P<0.05).Conclusions The occurrence of ATC in patients with sTBI is closely related to the increase of serum t-PAIC and TM.Serum t-PAIC and TM have certain predictive value for the occurrence of ATC in patients with sTBI,and the prediction efficiency of the combination of the two detection methods is better.
作者
李永海
杨宵曼
王新存
张俊鸣
王楠楠
LI Yonghai;YANG Xiaoman;WANG Xincun;ZHANG Junming;WANG Nannan(Department of Critical Care Medicine,Puyang People's Hospital,Puyang 457000,China)
出处
《中华神经外科疾病研究杂志》
2025年第3期58-63,共6页
Chinese Journal of Neurosurgical Disease Research
基金
河南省医学科技攻关项目(联合共建)计划项目(LGHJ20230794)。
