摘要
目的 探讨重型颅脑损伤患者回顾性分析血栓调节蛋白(TM)和血管性假血友病因子(vWf)血清水平的变化及其临床意义.方法 选择62例重型颅脑损伤患者的病历资料,将62例患者分为弥漫性轴索伤组(28例)和局限性脑损伤组(34例).然后将62例患者再分成青年组(16~30岁)20例、中年组(31~65岁)20例和老年组(>65岁)22例.分别于伤后1,3和7 d时测定TM及vWf的血清水平.TM及vWf血清水平采用酶联免疫吸附法(ELISA)测定.结果 局限性脑损伤组在伤后1~7 d的vWf值明显高于弥漫性轴索伤组(P<0.05);与中、青年组比较,老年组在伤后1 d TM、vWf血清水平明显升高(P<0.05);发生迟发性外伤性颅内血肿(delayed traumatic intracerebral hematoma,DTICH)患者的TM水平明显高于未发生DTICH患者的TM水平(P<0.05).结论 在重型颅脑损伤的急性期,不同损伤类型、不同年龄患者脑内皮细胞损伤和活化的程度不同;TM是反映脑血管内皮细胞损伤的敏感指标之一,通过测量TM和vWf血清水平来评估颅脑损伤预后以及把测量TM作为预测DTICH发生的指标是非常有意义的.
Objective To investigate the changes of thrombomodulin (TM) and von Willebrand factor (vWf) and their clinical significance in patients with severe brain injury. Methods The study involved 62 patients with severe brain injury who were divided into diffuse axonal injury group (28 patients) and focal brain injury group (34 patients). Then, the 62 patients were divided into young group (16-30 years old, 20 patients), middle-aged group (31-65 years old, 20 patients) and elderly group ( 〉65 years old, 22 patients). The serum levels of TM and vWf were determined at days 1 and 7 after injury respectively. ELISA method was employed to determine the serum levels of TM and vWf.Results The vWf in focal brain injury group was significantly higher than that of diffuse axonal injury group at days 1-7 after injury ( P 〈 0.05 ). Compared with the young and middle-aged groups, the TM and vWf levels in the elderly group at day 1 after injury were significantly elevated ( P 〈 0. 05 ). The TM levels in patients with delayed traumatic intracerebral hematoma (DTICH) were significantly higher than that in patients without DTICH (P 〈 0. 05). Conclusions In the acute stage of severe brain injury,injury severity and activation of endothelial cells varies in patients with different types of injury and at different ages. TM is one of sensitive indicators to reflect the cerebal vascular endothelial cell injury. It is very meaningful to assess the prognosis of severe brain injury by measuring serum levels of TM and vWf and take TM as a predictive indicator for DTICH.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2010年第11期999-1002,共4页
Chinese Journal of Trauma