凝血功能及血浆cTnI、HCY、PCT水平对急性颅脑损伤患者伤情严重程度和预后评价的临床意义

Clinical significance of coagulation function and plasma cTnI,HCY,PCT levels to severity and prognosis in patients with acute craniocerebral injury

目的:探讨凝血功能及血浆cTnI、HCY、PCT变化与急性颅脑损伤患者伤情严重程度及预后的关系。方法:选取我院收治的急性颅脑损伤患者80例为研究对象,按入院时格拉斯哥昏迷量表(GCS)评分将其分为轻型组(27例)、中型组(28例)、重型组(25例)3组,另选取同期入院体检的40例健康志愿者为健康对照组。检测受试者凝血功能的各项指标:活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、D-二聚体(DD)及纤维蛋白原(Fib)以及血浆肌钙蛋白I(cTnI)、同型半胱氨酸(HCY)、降钙素原(PCT)水平,并对比分析上述各项指标。患者治疗1个月后,根据干预效果进行格拉斯哥预后量表(GOS)评分,将其分为预后良好组(54例)和预后不良组(26例),观察两组患者上述指标变化情况。结果:⑴轻、中、重型组患者的PT、APTT、TT和DD水平均高于健康对照组,而Fib水平均低于健康对照组,差异均有统计学意义(P<0.05);随着急性颅脑损伤程度越重,PT、APTT、TT和DD水平越高而Fib水平越低,组内两两间比较差异有统计学意义(P<0.05)。⑵轻、中、重型组患者的cTnI、HCY、PCT水平均显著高于健康对照组(P<0.05);随着急性颅脑损伤程度越重,患者cTnI、HCY、PCT水平越高,组内两两间比较差异有统计学意义(P<0.05)。⑶预后良好组PT、APTT、DD、TT水平均显著低于预后不良组,而Fib水平显著高于预后不良组,差异均有统计学意义(P<0.05)。⑷预后良好组cTnI、HCY、PCT水平显著低于预后不良组,差异有统计学意义(P<0.05)。结论:颅脑损伤患者早期凝血功能以及血浆cTnI、HCY、PCT水平与颅脑损伤程度和预后有显著关系,监测以上各项指标对正确评估患者伤情严重程度、预后转归有指导作用。

Objective:To investigate the correlation of changes of coagulation function and plasma cTnI,HCY,PCT levels with cerebral trauma severity and prognosis in patients with acute craniocerebral injury.Method:A total of80patients with acute craniocerebral injury treated in our hospital from May2014to May2017were selected as the observation group and divided into3groups according to the admission GCS score:mild(27cases),moderate(28cases)and severe group(25cases).Besides,40healthy volunteers were selected as the control group.The index of blood coagulation(APTT,PT,Fib,TT,DD)and the levels of cTnI,HCY and PCT both in observation group and control group were detected and analysed comparatively.After1month of treatment,80patients were divided into the good prognosis group(54cases)and poor prognosis group(26cases)according to the GOS score and the levels of the above parameters were detected.Results:①The PT,APTT,TT and DD levels of the observation group with mild,moderate and severe acute craniocerebral injury were higher than those of the control group(P<0.05),but the level of Fib was lower than that of the control group(P<0.05).There was a significant difference between any two groups respectively(P<0.05).②The cTnI,HCY and PCT levels of the observation group with different degrees of acute craniocerebral injury were higher than those of the control group(P<0.05),and there was also a significant difference between any two groups respectively(P<0.05).③The indexes of PT,APTT and DD in the good prognosis group were lower than those in the poor prognosis group(P<0.05),while the Fib level was higher significantly(P<0.05).④The levels of cTnI,HCY and PCT in the good prognosis group were significantly lower than those in the poor prognosis group.The difference was statistically significant(P<0.05).Conclusions:The levels of coagulation function and plasma cTnI,HCY,PCT are correlated positively with the severity and prognosis of patients with craniocerebral injury.