创伤性脑损伤患者凝血酶-抗凝血酶复合物持续增高预示不良临床结局  

Continuous increase of thrombin-antithrombin complex monitoring in patients with traumatic brain injury indicates adverse clinical outcomes

作　　者：张伯玮[1] 任静[1] 张珠博 田野[1] 邓全军[1] 门剑龙[1] Zhang Bowei;Ren Jing;Zhang Zhubo;Tian Ye;Deng Quanjun;Men Jianlong(Precision Medicine Center,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院精准医学中心,天津300052

出　　处：《中华检验医学杂志》2021年第5期402-407,共6页Chinese Journal of Laboratory Medicine

摘　　要：目的研究凝血酶-抗凝血酶复合物(TAT)在颅脑创伤时的变化特征以及对不良临床结局的预测能力。方法研究纳入了2018年1月至2019年12月间的147例创伤性脑损伤(TBI)患者,其中男112例,女35例,年龄36(26~48)岁。测定TBI发生后第0、1、3、7天的血浆TAT含量,用Kruskal-Wallis H检验做多组间比对,用Mann-Whitney U检验做两组间数据比对;用Friedman秩和检验做同组内患者数据连续比对;用ROC分析TAT预测TBI患者30 d内不良事件的诊断性能;用Kaplan-Meier曲线做生存分析;用Cox比例风险回归模型做风险比(HR)分析。结果轻、中、重型患者各组内的第0、1、3、7天间比较显示,TAT水平均表现为第0天>第1天>第3天>第7天(χ2值分别为95.612、133.555和132.453,P值均<0.001)。不良事件组的第0、1、3、7天的TAT水平高于病情稳定组(U值分别为959.0、321.0、36.0、1.0,P值均<0.001)。在病情稳定组中,重型亚组第0、1天的TAT水平高于轻型亚组(U值分别为0和1.0,P值均<0.001),第3、7 d的TAT水平与轻型组间差异无统计学意义(U值分别为342.5、272.5,P值分别为0.486和0.065);中型亚组第0、1天的TAT水平高于轻型亚组(U值分别为0和280.0,P值均<0.001),第3、7天的TAT水平与轻型亚组间差异无统计学意义(U值分别为628.0、647.0,P值分别为0.826和0.996)。ROC显示,第0、1、3、7 d的TAT诊断临界值分别为68.75、29.05、17.25和13.85 ng/ml时,预测不良事件的敏感度分别为86.8%、94.3%、100.0%和100.0%,特异度分别为71.3%、78.7%、91.5%和96.8%;生存分析显示,高于上述临界值的患者发生不良临床结局的累积概率显著增高;Cox分析显示,第0、1、3、7天检测TAT预测不良临床结局的HR分别为1.818、2.257、3.526和4.813(P值均<0.001)。结论血浆TAT水平与患者病情严重程度密切相关,TAT持续增高能反映不良事件风险,可作为综合预判TBI患者病情发展趋势的有效指标。Objective Study on the feature of thrombin-antithrombin complex(TAT)during traumatic brain injury and the predicting performance with adverse clinical outcomes.Methods From January 2018 to December 2019,147 patients with traumatic brain injury(TBI)were enrolled,including 112 males and 35 females,aged 36(26-48)years old.The plasma levels of TAT were detected on the 0th,1st,3rd and 7th day after TBI attack.Kruskal-Wallis H test was used for comparison among multiple groups;Mann-Whitney U test was used for data comparison between the two groups;continuous comparison of patient data in the same group using Friedman rank test;the diagnostic performance of TAT with adverse event risk predicting was evaluated by ROC analysis;Kaplan-Meier curve was used to analyze the survival curve;the risk ratio(HR)was obtained by Cox proportional hazard regression model.Results Among the patients groups with mild,moderate and severe phenotype,the TAT levels were gradually decreased on the 0th,1st,3rd and 7th day after TBI attack(χ2 values were 95.612,133.555,and 132.453,respectively,all P values<0.001).The TAT levels on the 0th,1st,3rd and 7th day in the adverse event group were higher than in the group of patients with stable condition(U values were 959.0,321.0,36.0 and 1.0 respectively,all P values<0.001).In the stable condition group,the TAT levels on the 0th and 1st day in the severe group were higher than in the mild group(U values were 0 and 1.0 respectively,both P values<0.001),while there was no statistically significant difference of TAT levels between the 3rd and 7th day in the severe group(U values were 342.5 and 272.5,P values were 0.486 and 0.065 respectively).The TAT levels of the moderate group on 0th and 1st day were higher than those of the mild group(U values were 0 and 280.0,respectively,both P<0.001),while there was no significant difference between the TAT levels on the 3rd and 7th day(U values were 628.0 and 647.0,P values were 0.826 and 0.996,respectively).ROC curves analysis showed that when the TAT diagnostic

关 键 词：凝血酶-抗凝血酶复合物 创伤性脑损害 凝血病 

分 类 号：R651.15[医药卫生—外科学]