重型颅脑外伤患者早期TF、TFPI-1的变化

Early Changes of Tissue Factor and Tissue Factor Pathway Inhibitor-1 in Patients with Severe Head Injury

目的：探讨重型颅脑外伤患者早期组织因子（TF）、组织因子途径抑制物-1（TFPI-1）的变化及其与预后的关系。方法：选择重型颅脑外伤患者53例为观察组（根据伤后60 d的格拉斯哥预后评分分为预后良好亚组、预后不良亚组和死亡亚组）,同期健康体检者30例为对照组,采用ELISA法分别检测观察组入院第1、2、3、5、7天和对照组的血浆TF、TFPI-1水平。结果：观察组的TF在受伤后第1-2天明显升高,至伤后第5天达到峰值,此后下降,伤后第1、2、3、5、7天与对照组比较,差异均有统计学意义（P〈0.05）;TFPI-1在伤后第1天即开始降低,随时间延长进一步下降,至第7天又升高至接近正常。死亡亚组的TF水平高于预后不良亚组,预后不良亚组的TF水平高于预后良好亚组,差异均有统计学意义（P〈0.05）;死亡亚组的TFPI-1水平低于预后不良亚组,预后不良亚组的TFPI-1水平低于预后良好亚组,差异均有统计学意义（P〈0.05）。结论：重型颅脑外伤后早期存在凝血功能异常,动态检测血浆中TF、TFPI-1水平对早期判断病情和处理、评估疾病发展趋势和预后具有重要的临床意义。

Objective：To explore the early changes of tissue factor（TF） and tissue factor pathway inhibitor-1（TFPI-1） in patients with severe head injury and its relationship with prognosis. Methods： Fifty-three patients with severe head injury were enrolled as observation group（according to Glasgow outcome scale scores on60-day after the injury, the observation group was divided into subgroups of good prognosis, poor prognosis and death）, and 30 cases of healthy volunteers during the same period were enrolled as control group. The TF and TFPI-1 levels in plasma were measured by ELISA. Results： The TF level of the observation group increased significantly 1-2 days after the injury, reached the peak on day 5 after the injury and then fell. Compared with the control group, the TF level of the observation group had significantly different on days 1、2、3、5 and 7 after injury（P〈0.05）. The TFPI-1 level of the observation group began to decrease on day 1 after injury, which further decreased with time and then increased to normal level on day 7. The TF level in death subgroup was higher than the poor prognosis subgroup while the TF level in the poor prognosis subgroup was higher than that in the good prognosis subgroup（P〈0.05）; TFPI-1 level in the death subgroup was lower than that in the poor prognosis subgroup and the TFPI-1 level in the poor prognosis subgroup was lower than that in the good prognosis subgroup（P〈0.05）. Conclusion： The dysfunction of blood coagulation appears early after severe head injury. Dynamic detection of serum levels of TF and TFPI-1 is of important clinical value for early diagnosis, treatment and evaluation of disease and prognosis.