Kirmizis Dimitrios, Tsiandoulas Apostolos, Pangalou Maria, Koutoupa Evangelia, Rozi Paraskevi, Protopappa Maria, Barboutis Konstantinos
Department of Nephrology, Serres General Hospital, Serres, Greece.
Med Sci Monit. 2006 Feb;12(2):CR55-62. Epub 2006 Jan 26.
Among the non-classic cardiovascular disease risk factors in end-stage renal disease patients on chronic hemodialysis (HD), plasma fibrinogen, D-dimer, and von Willebrand factor (vWf) levels are potential markers of cardiovascular morbidity. We designed this case-control study to investigate their validity and any differences between them.
MATERIAL/METHODS: Twenty-five HD patients (18 males, mean age: 63, range: 52-69 years) comprised the group with prevalent cardiovascular disease (CVD) and 50 HD patients (35 males, mean age: 62, range: 40-77 years) with non-evident cardiovascular disease history constituted the second study group. Twenty-five healthy non-smoking volunteers served as controls for comparison with the study groups.
Patients with CVD had significantly higher concentrations of plasma fibrinogen, D-dimer, and vWf than patients without incident CVD. All three parameters correlated positively with cardiovascular morbidity, i.e. fibrinogen (r=0.378, P<0.001), logDD (r=0.70, P<0.001), vWf (r=0.214, P<0.001), and logCRP (r=0.704, P<0.001). Among them, D-dimer exhibited the characteristics most coherent with CVD. The age- and sex-adjusted odds ratio (OR) of D-dimer for the presence of CVD was 2.0, which did not change appreciably when adjustments for several pathophysiological clusters of variables were made, except for a marginal reduction in OR following adjustment for markers of inflammation.
Among the coagulation molecules studied, plasma D-dimer levels exhibited the characteristics most coherent with associated CVD and were found to be strongly and independently associated with the prevalence of CVD in HD patients.
在接受慢性血液透析（HD）的终末期肾病患者的非经典心血管疾病危险因素中，血浆纤维蛋白原、D - 二聚体和血管性血友病因子（vWf）水平是心血管疾病发病的潜在标志物。我们设计了这项病例对照研究来调查它们的有效性以及它们之间的差异。
材料/方法：25名HD患者（18名男性，平均年龄：63岁，范围：52 - 69岁）组成患有心血管疾病（CVD）的组，50名无明显心血管疾病史的HD患者（35名男性，平均年龄：62岁，范围：40 - 77岁）构成第二个研究组。25名健康非吸烟志愿者作为对照组与研究组进行比较。
患有CVD的患者血浆纤维蛋白原、D - 二聚体和vWf的浓度显著高于无CVD的患者。所有这三个参数与心血管疾病发病率呈正相关，即纤维蛋白原（r = 0.378，P < 0.001）、logDD（r = 0.70，P < 0.001）、vWf（r = 0.214，P < 0.001）和logCRP（r = 0.704，P < 0.001）。其中，D - 二聚体表现出与CVD最相关的特征。D - 二聚体在存在CVD时经年龄和性别调整的优势比（OR）为2.0，在对几个病理生理变量组进行调整时，该值没有明显变化，除了在对炎症标志物进行调整后OR略有降低。
在所研究的凝血分子中，血浆D - 二聚体水平表现出与相关CVD最相关的特征，并且发现其与HD患者CVD的患病率密切且独立相关。
