D-二聚体在创伤后颅内进展性出血性损伤中的变化及意义

Changes and clinical significance of D-dimer in progressive hemorrhagic injury after traumatic brain injury

目的探讨急性颅脑创伤后血浆D-二聚体变化及其与颅内进展性出血性损伤（PHI）的关系。方法回顾性分析108例颅脑创伤患者（PHI组48例，非PHI组60例）的临床资料，比较不同性别、年龄、受伤至首次CT检查时间、格拉斯哥昏迷评分、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血浆D-二聚体浓度对PHI发生的影响；Logistic回归分析PHI发生的危险因素；受试者工作特征（ROC）曲线计算血浆D-二聚体浓度与PHI发生的关系。结果PHI组的D-二聚体浓度为（7．08±3．87）mg／L，非PHI组为（4．34±3．21）mg／L，两组间差异有统计学意义（P〈0．05）。Logistic多元回归分析显示，受伤至首次CT检查时间和D-二聚体浓度与PHI的发生有关（分别为OR=0．407，95％CI：0．132—0．825，P=0．018和OR=1．254．95％CI：0．980～1．374，P=0．021）。ROC曲线推算D-二聚体浓度的最佳临界值为4．05mg／L，此时灵敏度和特异度分别为79％和70％，大于此值PHI的发生率达74，1％。结论颅脑外伤后血浆D-二聚体的水平可作为PHI发生的一个预判指标，结合影像学检查及其他相关临床因素分析可以更好地预判和及时诊断颅脑创伤后PHI的发毕。

Objective To detect the changes of D-dimer level in progressive hemorrhagic injury （PHI） after traumatic brain injury and explore the relationship between D-dimer level and PHI. Methods The medical records of 108 patients with traumatic brain injury （n = 48 in PHI group and n = 60 in non-PHI group） were retrospectively reviewed. The relationship between PHI and clinical factors such as sex, age, time from injury to first CT, Glasgow coma scale, prothrombin time （PT）, activated partial thromboplastin time （APTT） and plasma D-dimer values was analysed. Logistic multiple regression analysis was used to identify the risk factors of PHI. Receiver operating characteristic （ROC） curve was used to infer the relationship between plasma D-dimer level and prevalence of PHI. Results The plasma D-dimer levels were （7.08 ± 3.87） mg/L and （4.34 ± 3.21 ） mg/L, respectively in PHI group and non-PHI group （ P 〈 0.05）. It was revealed by multivariate Logistic regression analysis that the D-dimer level and time from injury to first CT were related to the occurence of PHI （ OR = 0. 407,95% CI：0. 132 -0. 825, P = 0. 018 and OR = 1. 254,95% CI：0. 980 - 1. 374, P = 0. 021, respectively）. It was indicated by ROC curve that the cutoff point was 4.05 mg/L, with the sensitivity of 79% and specificity of 70%. The percentage of patients suffered from progression was as high as 74.1% when the level of D-dimer 〉14.05 mg/L. Conclusion The level of plasma D-dimer after traumatic brain injury can be a prognostic factor for PHI. Combined with imaging findings and analysis of other related clinical factors, D-dimer level may play an important role in the diagnosis of PHI after traumatic brain injury.