单纯性颅脑创伤患者凝血因子Ⅶ活性与凝血功能障碍和进展性颅内出血性损伤的相关性分析

Activity of factor Ⅶ in patients with isolated blunt traumatic brain injury： association with coagulopathy and progressive hemorrhagic injury

目的 探讨单纯性颅脑创伤患者血浆凝血因子Ⅶ（FⅦ）活性与颅脑创伤性凝血功能障碍和进展性颅内出血性损伤的关系.方法 2010年8月至2012年12月根据研究纳入和排除标准,共收集复旦大学附属华山医院神经外科急救中心住院患者中年龄≥16岁中重度单纯性颅脑创伤患者81例,在到达神经外科急救中心后24 h内采集外周静脉血标本并送检国际化标准比值（INR）、活化部分凝血酶时间（aPTT）、血小板（PLT）和FⅦ凝血活性.入院时INR＞1.2和（或）aPTT＞40 s和（或）PLT＜120＆#215;109/L被诊断为颅脑创伤性凝血功能障碍;当随访头颅CT报告提示颅内血肿容积增大或出血性损伤部位增多时被诊断为进展性颅内出血性损伤.采用Logistic回归分析检验单纯性颅脑创伤后发生凝血功能障碍和进展性颅内出血性损伤的危险因素.结果 81例患者中凝血功能障碍组血浆FⅦ活性显著低于凝血功能正常组（86%＆#177;35%比100%＆#177;29%,P＆lt;0.05）.进展性颅内出血性损伤患者血浆FⅦ活性显著低于非进展患者（71%＆#177;18%比106%＆#177;33%,P＆lt;0.01）.逐步Logistic回归分析显示,血浆FⅦ活性＜77.5%是单纯性颅脑创伤患者发生进展性颅内出血性损伤的独立危险因素.单纯性颅脑创伤患者的死亡率为7.4%（6/81）,血浆FⅦa活性死亡组与幸存组分别为（91＆#177;47）% 、（ 92＆#177;32）%,P＞0.05,两组死亡率差异无统计学意义（P＞0.05）.结论 单纯性颅脑创伤患者FⅦ活性低下与凝血功能障碍密切相关;而FⅦa活性低下和凝血功能障碍是进展性颅内出血性损伤的独立危险因素.

Objective To explore the relationship of the activity of plasma FⅦ with isolated blunt traumatic brain injury and progressive hemorrhagic injury. Methods Eight-one isolated traumatic brain patients with moderate-to-severe injury, aged ≥16 yrs, were recruited from August 2010 to December 2012. The plasma factor Ⅶ activity was measured after admission. On arrival at emergency Department, blood samples were collected to analyze the parameters of activated partial thromboplastic time （aPTT）, international normalized ratio （INR）, platelet count and activity of factor Ⅶ. TBI-associated coagulopathy was defined as elevated international normalized ratio ＆gt;1.2 or prolonged activated partial thromboplastic time ＆gt;40 seconds or platelet count ＆lt;120＆#215;109/L at admission. Progressive hemorrhagic injury was present when follow-up computed tomography （CT） noted any increase in size or number of hemorrhagic lesions. Logistic regression examined the risks for coagulopathy and progressive hemorrhagic injury after isolated traumatic brain injury. Results FⅦ activity in patients with coagulopathy was 86%＆#177;35%. And it was significantly lower than those without coagulopathy （100＆#177;29%, P＆lt;0.05）. Isolated traumatic brain injury patients with FⅦ activity ＆lt;77.5% had an odds ratio for coagulopathy of 5.52 （95% confidence interval 1.82-16.68, P＆lt;0.05） relative to those with FⅦ activity≥77.5%. FⅦ activity in patients with progressive hemorrhagic injury was 71%＆#177;18%. And it was significantly lower than those without progressive hemorrhagic injury （106%＆#177;32%, P＆lt;0.001）. Stepwise Logistic regression analysis identified FⅦ＆lt;77.5% as a predisposing risk factor independently associated with the presence of progressive hemorrhagic injury. The overall mortality rate in the surveyed population was 7.4% （6/81）. The plasma FⅦ in deceased patients （91%＆#177;47%） was slightly lower than that in survivors （92%＆#177;32%, P〉0.05）. No significant difference existed between two groups （P〉0.05）. Conclusions Decreased activity of FⅦ is closely correlated with coagulopathy in patients with isolated blunt traumatic brain injury. And coagulopathy and decreased FⅦ activity are predisposing risk factors independently associated with progressive hemorrhagic injury.