Diverse activities of von Willebrand factor in traumatic brain injury and associated coagulopathy.
Diverse activities of von Willebrand factor in traumatic brain injury and associated coagulopathy.
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DOI：
10.1111/jth.15096
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Dong JF
中科院分区：
文献类型：
--
作者：
Xu X;Kozar R;Zhang J;Dong JF
创伤性脑损伤（TBI）是导致死亡和残疾的主要原因。孤立性TBI患者因原发损伤而失血量有限，但常发生继发性凝血功能障碍，导致迟发性或复发性颅内和脑内血肿。创伤性脑损伤引起的凝血功能障碍与这些患者的不良预后（包括死亡）密切相关。这种继发性凝血功能障碍本质上是消耗性的，不仅涉及脑源性分子、凝血因子和血小板，还涉及内皮细胞，这一复杂的过程现在被称为内皮病。一个关键的问题是，局部脑损伤是如何迅速扩散并影响全身止血的，因为它不像身体和四肢创伤那样直接影响止血，尤其是失血性休克。越来越多的证据表明，在内皮细胞中合成并从内皮细胞中释放的黏附配体血管性血液病因子（VWF）在促进损伤部位局部止血的同时，也在全身性地传播tbi诱导的内皮病和凝血功能障碍，发挥着矛盾的作用。这篇综述讨论了在了解VWF的这些不同活动方面的最新进展，以及在定义它们在TBI和相关凝血病中的作用方面的知识差距。
Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with isolated TBI lose a limited amount of blood to primary injury, but they often develop secondary coagulopathy, resulting in delayed or recurrent intracranial and intracerebral hematoma. TBI-induced coagulopathy is closely associated with poor outcomes for these patients, including death. This secondary coagulopathy is consumptive in nature, involving not only brain-derived molecules, coagulation factors, and platelets, but also endothelial cells in a complex process now called endotheliopathy. A key question is how a localized injury to the brain is rapidly disseminated to affect hemostasis systemically, as this is not directly affected the way it is in trauma to the body and limbs, especially with hemorrhagic shock. Increasing evidence suggests that the adhesive ligand von Willebrand factor (VWF), which is synthesized in and released from endothelial cells, plays a paradoxical role in both facilitating local hemostasis at the site of injury and also propagating TBI-induced endotheliopathy and coagulopathy systemically. This review discusses recent progress in understanding these diverse activities of VWF and the knowledge gaps in defining their roles in TBI and associated coagulopathy.
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DOI：
10.1073/pnas.061307098
发表时间：
2001-03-27
影响因子：
11.1
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影响因子：
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