外伤性脑损伤患者α - 2-纤溶酶抑制剂及α - 2-纤溶酶抑制剂复合物水平的时间变化

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY

Acta Neurochirurgica Pub Date : 2025-03-25 DOI:10.1007/s00701-025-06496-6

Takahiro Kanaya, Ryuta Nakae, Tetsuro Sekine, Yu Fujiki, Yasuhiro Takayama, Yutaka Igarashi, Go Suzuki, Yasutaka Naoe, Hiroyuki Yokota, Shoji Yokobori

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引用次数: 0

摘要

在急性期，创伤性脑损伤（TBI）以凝血/纤溶系统的紊乱为显著特征。纤溶蛋白、α2-纤溶蛋白抑制剂（α2-PI）及其复合物（纤溶蛋白-α2-PI复合物[PIC]）是凝血-纤溶系统的重要组成部分，但其在TBI急性期的病程及其与长期预后的关系尚不清楚。方法对84例连续的孤立性脑损伤患者进行回顾性分析，测定患者到达时、伤后第3、6、12小时、第1、3、7天的血浆α - 2- pi和PIC水平。采用广义线性混合模型（GLMM）分析良好结局组（损伤后6个月扩展格拉斯哥结局量表[GOS-E]为5-8）和不良结局组（损伤后6个月GOS-E为1-4）血浆α2-PI和PIC水平的差异。采用CT容积法评估入院初扫及随访时的血肿体积，并检测入院时血肿体积变化与血浆α2-PI、PIC水平的关系。结果97.6%的患者入院时血浆PIC水平异常高。在校正协变量的GLMM中，与预后良好组相比，预后差组从入院到损伤后3天的血浆α - 2- pi活性显著降低，而从入院到损伤后6小时的血浆PIC水平显著升高。入院时α2-PI活性与血肿体积变化呈负相关（Spearman相关系数，r = - 0.587, p = 0.001）。结论大多数患者损伤后立即激活纤溶酶，纤维蛋白溶解增强，而在一部分患者中，α2-PI抑制纤溶酶抑制导致的血肿扩张对预后有负面影响。

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The time course of alpha 2-plasmin inhibitor and plasmin-alpha 2-plasmin inhibitor complex levels in patients with traumatic brain injury

Background

In its acute phase, traumatic brain injury (TBI) is notable for disturbances in the coagulation/fibrinolysis system. Plasmin, alpha 2-plasmin inhibitor (α2-PI), and their complex (plasmin-α2-PI complex [PIC]) are important components of the coagulation-fibrinolytic system, but their time courses in the acute phase of TBI and their association with long-term prognosis are unknown.

Methods

We conducted a retrospective analysis of 84 consecutive patients with isolated TBI, during which plasma α2-PI and PIC levels were measured at the time of arrival, as well as at 3, 6, and 12 h, and on days 1, 3, and 7 post-injury. Differences in plasma α2-PI and PIC levels between the good outcome group (extended Glasgow Outcome Scale [GOS-E] of 5–8 at 6 months post-injury) and the poor outcome group (GOS-E of 1–4 at 6 months post-injury) were analyzed using a generalized linear mixed model (GLMM). The hematoma volume of the initial CT scan upon admission and the follow-up CT scan was evaluated using CT volumetry, and then the relationship between changes in hematoma volume and plasma levels of α2-PI and PIC at admission was examined.

Results

Abnormally high plasma PIC levels were observed at admission in 97.6% of the patients. In the GLMM adjusted for covariates, the poor outcome group had significantly lower plasma α2-PI activity from admission to 3 days post-injury and significantly higher plasma PIC levels from admission to 6 h post-injury compared to the good outcome group. A negative correlation was found between α2-PI activity at admission and changes in hematoma volume (Spearman’s correlation coefficient, r = − 0.587, p = 0.001).

Conclusions

These findings suggest that plasmin was activated and fibrinolysis enhanced immediately after injury in most patients, while in a subset of patients, hematoma expansion due to the suppression of fibrinolytic inhibition by α2-PI negatively affected the outcome.

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.