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目的探讨蛋白C途径在不同损伤程度创伤性脑损伤(TBI)患者凝血功能障碍中的作用。方法依据格拉斯哥评分(GCS)入组30例TBI患者,其中轻度、中度和重度TBI各10例,入院早期采集患者血液样本,检测其凝血功能及蛋白C途径相关凝血纤溶因子,比较不同损伤程度TBI患者凝血功能障碍及蛋白C途径在凝血功能障碍中的作用。结果 TBI患者纤维蛋白原(FIB)在中重度患者中明显降低(P<0.05),活化部分凝血酶原时间(APTT)和凝血酶原时间(PT)则显著性的延长(P<0.05),随着损伤程度加重D-二聚体水平显著增加。蛋白C(PC)在重度TBI患者中显著提高(P<0.05);凝血酶原片段1+2(PF1+2)在中重度TBI患者中较轻度TBI患者显著提高;组织纤溶酶原激活物(t PA)和1型纤溶酶原激活物抑制剂(PAI-1)在重度TBI患者中显著升高(P<0.05)。结论中重度TBI患者早期出现凝血功能障碍,蛋白C途径可能参与这一过程,这一结果有助于TBI患者早期凝血功能障碍的诊断和治疗。
Objective To investigate the role of protein C pathway in coagulation dysfunction in patients with traumatic brain injury (TBI) at different degrees of injury. Methods Thirty patients with TBI were selected according to the Glasgow Scale (GCS). Ten patients with mild, moderate and severe TBI were enrolled in the study. Blood samples were taken from the patients admitted early in the hospital to detect coagulation and fibrinolytic factors related to the protein C pathway. The role of coagulation dysfunction and protein C pathway in coagulation disorders in patients with TBI. Results The fibrinogen (FIB) in patients with TBI was significantly lower (P <0.05), and the APTT and PT were significantly longer in patients with TBI (P <0.05) D-dimer levels increased significantly with increasing severity of injury. Protein C (PC) was significantly increased in patients with severe TBI (P <0.05). Prothrombin fragment 1 + 2 (PF1 + 2) was significantly increased in patients with moderate and severe TBI compared with patients with mild TBI. Tissue plasminogen activator (T PA) and type 1 plasminogen activator inhibitor (PAI-1) were significantly increased in patients with severe TBI (P <0.05). Conclusions In patients with moderate-severe TBI, coagulation dysfunction occurs early and protein C pathway may be involved in this process. This result is helpful for the diagnosis and treatment of early coagulation dysfunction in TBI patients.