【摘要】 目的分析颅脑损伤患者血浆凝血酶敏感蛋白-1(TSP-1)、血浆组织因子(TF)水平,探讨二者与迟发性颅内血肿的关系。方法回顾性分析2017年8月至2019年8月本院收治的行开颅手术治疗的重型颅脑损伤患者115例,根据术后颅脑CT复查是否发生迟发性颅内血肿分为非迟发性颅内血肿组85例,迟发性颅内血肿组30例。收集比较患者一般资料;采用ELISA法测定并比较受试者血浆TSP-1、TF水平;采用COX分析影响颅脑损伤患者发生迟发性颅内血肿的危险因素;绘制ROC曲线分析血浆TSP-1、TF水平对颅脑损伤患者发生迟发性颅内血肿的诊断价值。结果非迟发性颅内血肿组与迟发性颅内血肿组创伤至手术时间、舒张压、GCS评分、颅骨骨折发生比例、基底池受压发生比例、血浆凝血酶时间水平比较差异有统计学意义(均P<0.05)。迟发性颅内血肿组患者血浆TSP-1、TF水平明显高于非迟发性颅内血肿组(均P<0.05)。创伤至手术时间久、颅骨骨折、TSP-1及TF水平高(HR=4.027,HR=1.708,HR=2.356,HR=2.267;均P<0.05)是颅脑损伤患者发生迟发性颅内血肿的独立危险因素。血浆TSP-1、TF水平单独检测及二者联合检测诊断颅脑损伤患者术后发生迟发性颅内血肿ROC曲线下面积分别为0.752、0.837、0.897。结论血浆TSP-1、TF水平异常增高可能与颅脑损伤患者术后发生迟发性颅内血肿有关,且二者联合检测对患者发生迟发性颅内血肿有较高诊断价值。更多还原

【Abstract】 Objective To analyze the levels of plasma thrombospondin-1(TSP-1) and tissue factor(TF) in patients with craniocerebral trauma, and to explore the relationship between them and delayed intracranial hematoma. Methods From August 2017 to August 2019, 115 patients with severe craniocerebral trauma who underwent craniotomy in our hospital were retrospectively analyzed. According to whether delayed intracranial hematoma occurred after craniotomy, they were divided into non delayed intracranial hematoma group(n=85) and delayed intracranial hematoma group(n=30). The general data of patients were collected and compared; the levels of TSP-1 and TF in plasma were measured by ELISA; COX analysis was used to analyze the risk factors of delayed intracranial hematoma in patients with craniocerebral trauma; ROC curve was drawn to analyze the diagnostic value of plasma TSP-1 and TF levels in patients with brain injury. Results There were statistically significant differences in the time from trauma to operation, diastolic blood pressure, GCS score, proportions of skull fracture and basilar cistern compression, and plasma thrombin time between non delayed intracranial hematoma group and delayed intracranial hematoma group(all P<0.05). The plasma levels of TSP-1 and TF in delayed intracranial hematoma group were significantly higher than those in non delayed intracranial hematoma group(all P<0.05). Long time from trauma to operation, skull fracture, high levels of TSP-1 and TF(HR=4.027, HR=1.708, HR=2.356, HR=2.267; all P<0.05) were independent risk factors for delayed intracranial hematoma in patients with craniocerebral trauma. The area under the ROC curve of TSP-1 and TF single and combined detection in the diagnosis of delayed intracranial hematoma in patients with craniocerebral trauma were 0.752, 0.837 and 0.897, respectively.Conclusion The abnormal high levels of TSP-1 and TF may be related to the occurrence of delayed intracranialhematoma in patients with craniocerebral trauma,and the combined detection of TSP-1 and TF has high diagnostic value for patients with delayed intracranial hematoma.更多还原