创伤性脑损伤患者血小板、白细胞的动态变化及临床意义  

Dynamic changes of platelets and white blood cells in patients with traunmtic brain injury and its dinical significance

作　　者：贾叶华[1] 陈心[1] 熊建华[1] 张建宁[1] 

机构地区：[1]天津医科大学总医院神经外科、神经病学研究所,300052

出　　处：《中华创伤杂志》2009年第8期725-728,共4页Chinese Journal of Trauma

基　　金：国家重点基础研究发展计划资助项目（2005CB522605）;国家自然科学基金资助项目（30772229）天津市科技发展计划项目（05YFGDSF02500）

摘　　要：目的探明创伤性脑损伤患者白细胞（WBC）、血小板（PLT）的动态变化及临床意义。方法采用血细胞分析仪测定63例创伤性脑损伤患者不同时间点的白细胞与血小板数量，并结合GOS、是否合并感染进行比较分析。同时采用ELISA法观测C反应蛋白（CRP）、凝血酶敏感蛋白1（TSP1）的浓度变化并进行相关分析。结果患者是否合并感染WBC在伤后24h内部显著增高（P〈0．01），非感染组患者在4d时与正常对照组比较，差异无统计学意义（P〉0．05），降至10×10^9／L以下，但感染组患者4d时仍高于正常（P〈0．05）。感染及预后不良患者WBC在7～14d出现二次升高，PLT在14～21d显著升高（P〈0．01）。TSP1浓度变化与CRP呈正相关关系（r=0．720，P〈0．01）。结论WBC的动态变化为预防性抗生素使用提供依据；感染可能引起患者后期高凝状态，注意监测感染患者14～21dPLT的变化；WBC二次升高及PLT后期升高影响患者预后；TSP1与CRP可能参与炎症引发血栓形成的过程。Objective To investigate the dynamic changes of platelets （PLT） and white blood cells （WBC） after traumatic brain injury （TBI） and discuss its clinical significance. Methods The number of PLT and WBC were examined in 63 patients with TBI by using cytoanalyze and also analyzed together with Glasgow Outcome Scale and concurrent infection. In the meantime, enzyme-linked immunosorbent was used to investigate concentration changes of C reactive protein （CRP） and thrombospondin 1 （ TSP1 ） and analyze the correlation between CRP and TSP1. Results The number of WBC in all patients, whether concurred with infection or not, was significantly increased within 24 hours after TBI （ P 〈 0.01 ）, with no statistical difference between patients without infection at day 4 and normal patients （ P 〉0.05）. However, the number of WBC was decreased to below 10 × 10^9/L in patients without infection, which was significantly higher than that in normal patients （P 〈 0.05）. In patients with infection and unfavorable prognosis, the number of WBC was increased again ay days 7-14, whereas that of PLT rose significantly at days 14-21 （P 〈 0.01 ）. The concentration of TSP1 was positively correlated with that of CRP （r = 0. 720,P 〈0.01 ）. Conclusions Monitoring the dynamic changes of PLT and WBC is promising. The change of WBC at day 4 post injury is a key indicator to provide evidences of prophylactic antibiotic usage. Much attention should be paid to the dynamic change of PLT at days 14-21 post injury so as to evaluate the condition of hypercoagulability that can be potentially caused by inflammation response. Secondary increase of WBC and later increase of PLT may affect prognosis of the patients. TSP1 and CRP may participate in thrombosis formation induced by inflammation.

关 键 词：脑损伤 血栓形成 炎症 血小板 白细胞 

分 类 号：R651.15[医药卫生—外科学]