摘要
目的 探讨肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6和血小板活化因子（PAF）与重症颅脑损伤后凝血功能障碍的相关性和作用机制.方法 选择2009年1月至2012年6月创伤指数≥17分、格拉斯哥昏迷量表评分≤10分、除外合并其他部位损伤及在急诊科死亡的重症颅脑损伤患者65例（观察组）,在救治的同时检测血小板计数（PLT）、活化部分凝血活酶时间（APPT）、凝血酶原时间（PT）、D-二聚体（D-D）及TNF-α、IL-6、PAF,选取同期健康体检者43例作为对照组,比较两组上述指标的差异.结果 与对照组比较,观察组PLT减少,APTT及PT明显延长,D-D明显升高,差异均有统计学意义[（74.91±30.70）×109/L比（191.52±23.31）×109/L、（69.44±15.52）s比（22.47±9.41）s、（30.37±8.22）s比（9.57±4.53）s、（1 934.92±708.49） U/L比（105.78±44.53） U/L] （P＜0.01）.与对照组比较,观察组TNF-α、IL-6和PAF升高[（39.93±18.88） μg/L比（1.28±0.59）μg/L、（417.61±73.66） μg/L比（63.93±41.49） μg/L、（16 359.91±4 321.92） ng/L比（3 823.45±529.72） ng/L],差异均有统计学意义（P＜0.01）.观察组PLT与TNF-α、IL-6和PAF呈负相关（r=-0.929 2,-0.944 5,-0.932 4,P＜0.01）,APTT与TNF-α、IL-6和PAF呈正相关（r=0.910 2,0.932 7,0.9786,P＜ 0.01）,PT与TNF-α、IL-6和PAF呈正相关（r=0.934 1,0.9554,0.9786,P＜0.01）,D-D与TNF-α、IL-6和PAF呈正相关（r=0.9421、0.9438、0.9418,P＜0.01）.结论 TNF-α、IL-6、PAF参与了重症颅脑损伤后凝血功能障碍的发生、发展.急诊救治重症颅脑损伤患者时应对TNF-α、IL-6、PAF进行早期干预,减轻应激反应、炎性反应,或许可能改善重症颅脑损伤患者的凝血功能,防止或减轻凝血功能障碍,降低重症颅脑损伤患者的病死率.
Objective To investigate the correlation between tumor necrosis factor （TNF）-α,interleukin （IL）-6,platelet activating factor （PAF） with the blood coagulation disorder in severe craniocerebral injury.Methods Collected 65 subjects （observation group） with severe craniocerebral injury from January in 2009 to June in 2012 with the trauma index ≥17 points,glasgow coma scale ≤ 10 points,combined with other parts of the injury and died in the emergency department were excluded.Examined platelet count （PLT）,activated partial thromboplastin time （APTT）,prothrombin time （PT）,D-dimer （D-D）,TNF-α,IL-6 and PAF meanwhile were emergency treated,selected the same period 43cases of health as control group,these indicators were compared.Results PLT in observation group was significantly lower than that in control group [（74.91 ± 30.70） × 109/L vs.（191.52 ± 23.31） × 109/L] （P ＜0.01）,APTT,PT in observation group was significantly longer than that in control group [（69.44 ± 15.52） s vs.（22.47 ± 9.41） s,（30.37 ± 8.22） s vs.（9.57 ±4.53） s] （P ＜0.01）,D-D,TNF-α,IL-6,PAF in observation group was significantly higher than that in control group[（1 934.92 ± 708.49） U/L vs.（105.78 ± 44.53） U/L,（39.93 ± 18.88） μg/L vs.（1.28 ±0.59） μg/L,（417.61 ±73.66） μg/L vs.（63.93 ±41.49） μ g/L,（16 359.91 ±4 321.92） ng/L vs.（3 823.45 ±529.72） ng/L]（P＜0.01）.PLT in observation group was negatively correlated with TNF-α,IL-6 and PAF （r =-0.929 2,-0.944 5,-0.932 4,P ＜ 0.01）,APTT was positively correlated with TNF-α,IL-6 and PAF （r =0.910 2,0.932 7,0.978 6,P ＜0.01）,PT was positively correlated with TNF-α,IL-6 and PAF （r =0.934 1,0.955 4,0.978 6,P ＜ 0.01）,D-D was positively correlated with TNF-α,IL-6 and PAF （r =0.942 1,0.943 8,0.941 8,P ＜ 0.01）.Conclusions TNF-α,IL-6 and PAF all participate in the process of the blood coagulation disorder in severe craniocerebral injury.The inchoate interference and trea
出处
《中国医师进修杂志》
2014年第5期31-34,共4页
Chinese Journal of Postgraduates of Medicine
关键词
颅脑损伤
肿瘤坏死因子Α
白细胞介素6
血小板活化因子
凝血功能障碍
Craniocerebral trauma
Tumor necrosis factor-alpha
Interleukin-6
Platelet activating factor
Blood coagulation disorders
