凝血-纤溶失衡与颅脑损伤严重程度的关系及对急性创伤性凝血病的预测价值

Relationship between coagulation and fibrinolysis imbalance and severity of craniocerebral injury and its predictive value for acute traumatic coagulopathy

目的分析凝血-纤溶失衡与颅脑损伤严重程度的关系及对急性创伤性凝血病的预测价值。方法选择衢州市人民医院2017年1月—2020年10月接诊的145例颅脑损伤患者作为研究对象,使用格拉斯哥昏迷评分(GCS)评价严重程度,分为重度组(42例)和非重度组(103例)。以凝血酶-抗凝血酶复合物(TAT)与纤溶酶-α2纤溶酶抑制物复合物(PIC)比值评价凝血-纤溶失衡程度,比较2组凝血功能指标及TAT/PIC值,使用ROC曲线评价TAT/PIC值对急性创伤性凝血病的预测效能。结果重度组活化部分凝血活酶时间(APTT)长于非重度组[(33.69±8.16)s vs.(25.43±5.87)s],D-二聚体水平高于非重度组[(3.57±1.23)mg/L vs.(1.47±0.47)mg/L],TAT/PIC值低于非重度组[(0.75±0.11)×10^(-3) vs.(1.77±0.24)×10^(-3)],差异均有统计学意义(均P<0.05);经Pearson相关性分析,TAT/PIC值与GCS评分呈正相关关系(P<0.05);在145例颅脑损伤患者中,发生急性创伤性凝血病21例,占14.48%;急性创伤性凝血病患者入院后TAT/PIC值有明显降低趋势,入院后12、24 h的TAT/PIC值均较入院时降低,差异均有统计学意义(均P<0.05);经多因素logistic回归分析,TAT/PIC值、APTT和D-二聚体均为急性创伤性凝血病的独立预测因素(均P<0.05);经ROC曲线分析,TAT/PIC值预测急性创伤性凝血病的AUC为0.918。结论凝血-纤溶失衡与颅脑损伤严重程度呈正相关关系,而TAT/PIC值降低,预示急性创伤性凝血病发生的风险较大。

Objective To analyse the relationship between coagulation and fibrinolysis imbalance and the severity of craniocerebral injury and its predictive value in acute traumatic coagulopathy.Methods A total of 145 patients with craniocerebral injury admitted to our hospital from January 2017 to October 2020 were selected as subjects.The severity of the patients was evaluated by Glasgow Coma Scale(GCS),and patients were divided into the severe group and non-severe group.The ratio of thrombin-antithrombin complex(TAT)/plasminolysin-α2 plasminolytic inhibitor complex(PIC)was used to evaluate the degree of coagulation-fibrinolytic imbalance.The coagulation function indexes and the ratio of TAT/PIC were compared between the two groups.The predictive effect of TAT/PIC ratio on acute traumatic coagulopathy was evaluated by area under the receiver operating characteristic(ROC)curve(AUC).Results The activated partial thromboplastin time(APTT)in the severe group was longer than that in the non-severe group[(33.69±8.16)s vs.(25.43±5.87)s],the level of D-dimer was higher than that in the non-severe group[(3.57±1.23)mg/L vs.(1.47±0.47)mg/L],and the TAT/PIC ratio was lower than that in the non-severe group[(0.75±0.11)×10^(-3) vs.(1.77±0.24)×10^(-3)],the difference was statistically significant(P<0.05).Pearson correlation analysis showed that the TAT/PIC ratio was positively correlated with GCS score(P<0.05).Amongst 145 patients with craniocerebral injury,21 cases(14.48%)had acute traumatic coagulopathy.The TAT/PIC ratio of the acute traumatic coagulation disease group was significantly decreased after admission,and the TAT/PIC ratio at 12 and 24 h after admission was significantly decreased compared with that at admission,the difference was statistically significant(all P<0.05).Multivariate logistic regression analysis showed that the TAT/PIC ratio,APTT and D-dimer were independent predictors of acute traumatic coagulation disease(all P<0.05).Using ROC curve analysis,the AUC of the TAT/PIC ratio in predicting acute traumatic coagulopathy was 0.918.Conclusion Coagulation-fibrinolysis imbalance is positively correlated with the severity of craniocerebral injury,and the decrease of TAT/PIC ratio indicates a greater risk of acute traumatic coagulopathy.