蛋白C途径在创伤性脑损伤后凝血功能异常中的作用研究  

The roles of protein C pathway in the coagulopathy after traumatic brain injury

作　　者：陈江 夏小学 高树山 朱勇金 洪泽 冯玛静 吕中华 刘新兵 刘新林 

机构地区：[1]浙医二院长兴分院长兴县人民医院,浙江湖州313100

出　　处：《浙江创伤外科》2016年第4期611-614,共4页Zhejiang Journal of Traumatic Surgery

基　　金：湖州市科技局资助项目(2014GY32)

摘　　要：目的探讨蛋白C途径在不同损伤程度创伤性脑损伤(TBI)患者凝血功能障碍中的作用。方法依据格拉斯哥评分(GCS)入组30例TBI患者,其中轻度、中度和重度TBI各10例,入院早期采集患者血液样本,检测其凝血功能及蛋白C途径相关凝血纤溶因子,比较不同损伤程度TBI患者凝血功能障碍及蛋白C途径在凝血功能障碍中的作用。结果 TBI患者纤维蛋白原(FIB)在中重度患者中明显降低(P<0.05),活化部分凝血酶原时间(APTT)和凝血酶原时间(PT)则显著性的延长(P<0.05),随着损伤程度加重D-二聚体水平显著增加。蛋白C(PC)在重度TBI患者中显著提高(P<0.05);凝血酶原片段1+2(PF1+2)在中重度TBI患者中较轻度TBI患者显著提高;组织纤溶酶原激活物(t PA)和1型纤溶酶原激活物抑制剂(PAI-1)在重度TBI患者中显著升高(P<0.05)。结论中重度TBI患者早期出现凝血功能障碍,蛋白C途径可能参与这一过程,这一结果有助于TBI患者早期凝血功能障碍的诊断和治疗。Objective To explore the roles of protein C pathway in the coagulopathy after different severity of traumatic brain injury（TBI）. Methods A total of 30 cases of TBI patients including 10 cases of mild TBI, 10 cases of moderate TBI and 10 cases of severe TBI were enrolled in our present study according to the Glasgow Coma Scale（GCS）. Blood samples were collected in the early stage of the admission, and used for coagulation and protein C pathway analysis. The changes of coagulation and protein C pathway were compared. Results Compared with mild TBI patients ,the level of fibrinogen（FIB） decreased significantly in both moderate and severe TBI patients ,while the prothrombin time（PT） and activated partial thromboplastin time（APTT） were prolonged significantly （P〈0.05）. The concentrations of D-dimer increased dramatically with the TBI aggravated. The levels of protein C （PC） in the severe TBI patients were higher than that in mild-moderate TBI patients. The concentrations of prothrombin fragments 1＋2（PF1＋2） increased obviously in moderate-severe TBI patients. Other two factors of fibrinolytic system,tissue plasminogen activator（tPA） and plasminogen activator inhibitor 1 （PAI-1）,also increased in the severe TBI patients （P〈0.05）. Conclusions Early coagulopathy were found in the moderate-severe TBI patients. The PC pathway might participate in the development of coagulopathy. This novel findings might provide new insights on the treatment of eoagulopathy after moderate-severe TBI.

关 键 词：创伤性脑损伤 凝血功能异常 蛋白C途径 

分 类 号：R651.1[医药卫生—外科学]