D-二聚体在儿童颅脑创伤后的变化及意义

The clinical significance of D-dimer for prediction of traumatic brain injury in children

目的探讨D-二聚体是否可以替代头颅CT用来估测小儿存在创伤性脑损伤。方法对2006年1月～2010年3月就诊于该院急诊的116例脑外伤患儿进行前瞻性队列观察研究,同时登记他们的临床资料,测定电解质、凝血功能、血常规等相关指标。采用相关统计,分析哪个指标可以替代脑CT用来评估患儿脑部损伤情况。结果单变量及Logistic回归分析发现,血浆D-二聚体水平可用来评估患儿的脑损伤情况的独立预测因子(P<0.01),且优于格拉斯哥评分(GCS)。500 pg/μL作为临界点的特异度是94%。其他的指标,如血浆凝血酶原时间、凝血活酶时间等不能用来评估患儿的脑损伤情况。结论 D-二聚体水平较低的患儿多未见明显的脑损伤,可替代头颅CT用于评估患儿的脑损伤情况。

【Objective】 To investigate whether plasma D-dimer levels could replace head CT to predict the traumatic brain injury（TBI） of children or not.【Methods】 A prospective cohort observational study was conducted of 116 children with traumatic brain injury between Jan 2006 and Mar 2010 from the pediatric traumatic center of our hospital.At the time of initial evaluation,blood was obtained to measure electrolytes,coagulation makers,complete blood count.The general data were recorded from the data bank of our center.The related statistical analysis was done to evaluate the predictive value of appropriate biomarkers for traumatic brain injury instead of head CT.【Results】 Plasma levels of D-dimer were associated with TBI on head CT by univariate analysis（P〈0.01）.It was an independent predictor for TBI instead of head CT and stronger than the baseline Glasgow Coma Scale（P =0.08）.AD-dimer level cut-off 500 pg/μL had 94% negative predictive value（P〈0.01） for brain injury on head CT.Other makers including prothrombin time,partial thromboplastin time and so on were not.【Conclusions】 In children who meet clinical criteria for a head CT scan after trauma,low plasma D-dimer suggests the absence of significant brain injury.