弥漫性血管内凝血评分对创伤性脑损伤患者预后的预测价值  

Prognostic value of disseminated intravascular coagulation in patients with traumatic brain injury

作　　者：袁强[1] 吴惺[1] 卢香琼 孙一睿[1] 虞剑[1] 吴雪海[1] 李智奇[1] 杜倬婴[1] 胡锦[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]苏州大学附属第一医院急诊医学科

出　　处：《中华创伤杂志》2015年第8期676-680,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（81471241,81271375,81171133）

摘　　要：目的评估弥漫性血管内凝血（DIC）评分对创伤性脑损伤患者（TBI）预后的预测作用。方法收集2010年1月-2014年1月急诊入院的209例中、重度TBI[入院时格拉斯哥昏迷评分（GCS）3～12分]患者资料。根据国际血栓与止血学会颁布的DIC诊断标准（国际DIC评分）以及日本卫生部颁布的DIC诊断标准（日本DIC评分）对每位患者进行DIC评分，计算DIC评分预测进展性颅内出血（PHI）和预后的受试者工作特征（ROC）曲线下面积（AUC）。结果日本DIC评分AUC95％CI为0．847（0．795—0．898），对PHI预测能力显著高于其他单一凝血功能指标。而国际DIC评分和日本DIC评分对6个月死亡[AUC95％C1分别为0．734（0．644—0．824）和0．708（0．612—0．804）]和不良预后[AUC95％C1分别为0．640（0．566～0．714）和0．606（0．530～0．682）]的预测能力也较其他单项凝血功能指标高。将国际DIC评分和日本DIC评分分别加入死亡预测模型后，预测概率的AUC分别增加至0．811（95％C10．741—0．880）和0．795（95％C10．722—0．868）。结论DIC评分对TBI患者PHI和预后的预测能力强于单一凝血功能指标，且将其纳入传统TBI预测指标可以增加对患者预后的预测能力。Objective To evaluate the role of disseminated intravascular coagulation （DIC） for prognosis prediction in patients with traumatic brain injury （TBI）. Methods The retrospective review collected 209 patients with moderate to severe TBI （admission GCS score of 3-12 points） emergently admitted between January 2010 and January 2014. DIC score was calculated for each patient according to the modified diagnostic criteria for DIC by the International Society of Thrombosis and Hemostasis （international DIC score） and for DIC by the Japanese Ministry of Health and Welfare （Japanese DIC score） respectively. A receiver-operating characteristic （ROC） curve analysis based on the two DIC scores was made to calculate the area under curve （AUC） for prediction of progressive hemmorhage injury （PHI） and prognosis. Results AUC （95%C1） of Japanese DIC score was 0.847（0.795-0.898）, indicating a higher predictive value of PHI over other single coagulation index. International DIC score and Japanese DIC score for 6-month mortality [ AUC 0. 734 （95% CI 0. 644-0. 824） and AUC O. 708 （95%CI 0. 612-0. 804）, respectively] and for 6-month unfavorable outcome [ AUC 0. 640 （95% CI 0. 566-0. 714） and 0. 606 （ 95% CI 0. 530-0. 682 ）, respectively ] showed higher predictive value compared to other single coagulation index. When the international DIC score and Japanese DIC score were added into the predictive model of motality, the AUC were increased to 0. 811 （95% CI 0. 741- 0. 880） and 0. 795 （95% CI 0. 722-0. 868） respectively. Conclusions Predictive value of DIC score for PHI and prognosis in TBI patients is higher than other single coagulation index. Combination of DIC score with traditional predictive model can increase the prediction ability on mortality of the TBI patients.

关 键 词：颅脑损伤 弥漫性血管内凝血 预后 预测 

分 类 号：R651.15[医药卫生—外科学]