Koenig W, Rothenbacher D, Hoffmeister A, Griesshammer M, Brenner H
Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, University of Ulm, Ulm, Sweden.
Arterioscler Thromb Vasc Biol. 2001 Oct;21(10):1701-5. doi: 10.1161/hq1001.097020.
Increased levels of fibrin D-dimer are indicative of a hypercoagulable state, as found in acute coronary syndromes. Few well-controlled studies have assessed D-dimers in patients with stable coronary artery disease (CAD). We measured levels of D-dimers (in ng/mL by enzyme-linked immunosorbent assay) in 312 patients with angiographically proved CAD and stable angina pectoris and in 477 age- and sex-matched healthy blood donors. Demographic characteristics were assessed by a standardized questionnaire, and a complete lipid profile was performed for all subjects. In addition, a variety of other markers of hemostasis and inflammation were measured. The distribution of D-dimer levels was skewed to the right, and plasma median levels were higher in cases than in controls (median: 11.2 vs 2.8 ng/mL; P<0.001). In controls, correlations of D-dimer were found with fibrinogen, plasma viscosity, and interleukin-6. In logistic regression analysis, the age- and sex-adjusted odds ratio (OR) for the presence of CAD was 2.6 (95% confidence interval [CI], 1.9 to 3.5) when the highest quartile of the D-dimer distribution was compared with the combined lower 3 quartiles. The OR did not change appreciably after controlling for nonlipid risk factors (OR, 2.7; 95% CI, 1.9 to 3.9) and remained significant after further adjustment for other hemostatic parameters (OR, 2.4; 95% CI, 1.7 to 3.3) and markers of inflammation (OR, 2.1; 95% CI, 1.5 to 2.9). Plasma D-dimer levels are strongly and independently associated with the presence of CAD in patients with stable angina pectoris. These results support the concept of a contribution of intravascular fibrin to atherothrombogenesis.
纤维蛋白D - 二聚体水平升高表明处于高凝状态，如在急性冠脉综合征中所见。很少有严格对照的研究评估过稳定型冠心病（CAD）患者的D - 二聚体水平。我们通过酶联免疫吸附测定法测量了312例经血管造影证实患有CAD且有稳定型心绞痛的患者以及477例年龄和性别匹配的健康献血者的D - 二聚体水平（单位为ng/mL）。通过标准化问卷评估人口统计学特征，并对所有受试者进行完整的血脂谱检测。此外，还测量了多种其他止血和炎症标志物。D - 二聚体水平的分布向右偏态，病例组的血浆中位数水平高于对照组（中位数：11.2 vs 2.8 ng/mL；P<0.001）。在对照组中，发现D - 二聚体与纤维蛋白原、血浆粘度和白细胞介素 - 6相关。在逻辑回归分析中，当将D - 二聚体分布的最高四分位数与较低的3个四分位数合并组进行比较时，CAD存在的年龄和性别调整后的优势比（OR）为2.6（95%置信区间[CI]，1.9至3.5）。在控制非脂质危险因素后，OR没有明显变化（OR，2.7；95%CI，1.9至3.9），在进一步调整其他止血参数（OR，2.4；95%CI）和炎症标志物（OR，2.1；95%CI，1.5至2.9）后仍具有显著性。血浆D - 二聚体水平与稳定型心绞痛患者CAD的存在密切且独立相关。这些结果支持血管内纤维蛋白对动脉粥样硬化血栓形成有贡献的概念。
