Plasma α2-antiplasmin,vWF and ET-1 levels in patients with coagulation dysfunction after severe traumatic brain injuries and risk factor analysis
Objective To explore the expression of plasma α2-antiplasmin(α2-AP),von Willebrand fac-tor(vWF)and endothelin-1(ET-1),and influencing factors in patients with coagulation dysfunction after severe traumatic brain injuries(TBI).Methods A total of 106 severe TBI patients(GCS score＜9)admitted to the Neu-rosurgery Department of Nanyang First People's Hospital and Xinxiang Central Hospital between Jan.2021 and Dec.2022 were retrospectively analyzed,including 58 males and 48 females aged 32-60(mean 43.7)years.Ac-cording to the incidence of coagulation dysfunction within 24 h after TBI,patients were divided into normal coagula-tion group(74 cases)and coagulation disorder group(32 cases).Clinical data,levels of coagulation function-relat-ed indexes and plasma α2-AP,vWF and ET-1 in the morning of the 2nd day of admission were compared between the two groups.The relationship between plasma α2-AP,vWF,ET-1 and coagulation function-related indexes was analyzed by Pearson correlation analysis.The risk factors for coagulation dysfunction were analyzed by Logistic re-gression analysis.The predictive value of plasma α2-AP,vWF and ET-1 for coagulation dysfunction in patients with severe TBI was analyzed by receiver operating characteristic(ROC)curves.Results Comparison between the nor-mal coagulation group and coagulation disorder group showed significant differences in terms of age(years,45.4± 5.7 vs.42.8±4.2),GCS score(6.7±1.1 vs.7.2±0.9),the highest head AIS(4.6±0.8 vs.3.7±0.6)and mean arterial pressure(MAP)on admission(mmHg,84.1±11.2 vs.91.0±9.7 mmHg,all P＜0.05).The coagulation disorder group revealed much higher levels of PT(s,27.9±3.4 vs.12.0±1.9),APTT(s,66.4±5.8 vs.36.2± 2.3),INR(1.6±0.2 vs.1.0±0.1),and plasma levels of α2-AP(mg/L,67.8±8.2 vs.19.3±2.4),vWF(162.5％± 24.6％vs.94.8％±10.4％)and ET-1(mg/L,65.1±5.2 vs.41.6±3.9)while much lower level of fibrinogen(FIB,g/L,2.6±0.3 vs.3.9±0.5,all P＜0.05 compared with normal coagulation group).Pearson correlation analysis showed that plasma α2-AP,vWF and ET-1 were positively correlated with PT(r=0.723,0.528,0.586,all P＜0.05),APTT(r=0.646,0.572,0.585,all P＜0.05)and INR(r=0.592,0.507,0.548,all P＜0.05),while negatively correlated with FIB(r=-0.653,-0.672,-0.526,all P＜O.05).Logistic regression analysis showed that decreased GCS score at admission(OR=2.593,95％CI:1.018-6.606,P＜0.05),increased α2-AP level(OR=3.019,95％CI:1.107-8.236,P＜0.05)and increased vWF level(OR=2.729,95％CI:1.028-7.243,P＜0.05)were risk factors for coagulation dysfunction in patients with severe TBI.The AUC by ROC curve analysis of α2-AP,vWF and ET-1 in predicting coagulation dysfunction in severe TBI patients were 0.887(95％CI:0.805-0.969,P＜0.05),0.828(95％CI:0.734-0.922,P＜0.05)and 0.807(95％CI:0.695-0.918,P＜0.05),respectively.When the three factors were used combinedly,the AUC,sensitivity and specificity reached 0.912(95％CI:0.854-0.970,P＜0.05),91.67％and 87.14％,respectively.Conclusion The levels of plasma α2-AP,vWF and ET-1 signifi-cantly increase in patients with coagulation dysfunction after severe TBI.The increased levels of α2-AP and vWF are risk factors for coagulation dysfunction in patients with severe TBI.
Traumatic brain injuriesCoagulation dysfunctionPlasma α2-antiplasminvon Willebrand factorEndothelin-1Predictive value
NETL
NSTL
万方数据
维普
