Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
J Vasc Surg. 2011 Dec;54(6 Suppl):48S-55S. doi: 10.1016/j.jvs.2011.05.097. Epub 2011 Sep 3.
Soluble p-selectin (sP-selectin), D-dimer, and C-reactive protein (CRP) are elevated in deep vein thrombosis (DVT), and may play a role as risk predictors of recurrent venous thromboembolism. However, these parameters have only been assessed at manifestation or at single time points after DVT so far. We therefore investigated the course of sP-selectin, D-dimer, and high-sensitivity (hs)-CRP after acute unprovoked DVT of the lower limb.
In this prospective, longitudinal study, sP-selectin, D-dimer, and hs-CRP were determined by enzyme-linked immunosorbent assay, quantitative latex assay, and particle enhanced immunonephelometry, respectively, in 44 patients with sonographically confirmed acute DVT at the time of diagnosis, and 1, 3, 6, and 12 months later. sP-selectin and hs-CRP were also measured in 88 age- and gender-matched healthy controls. Further, color duplex sonography was performed in all patients at each time point.
At DVT diagnosis, sP-selectin and hs-CRP were significantly higher in patients compared with healthy controls. From baseline to 1 month, both parameters decreased significantly. In patients with oral anticoagulation (OAC) for 6 months (n = 35), levels of sP-selectin increased significantly after cessation of anticoagulant therapy (P = .002), while sP-selectin was similar to healthy controls in patients with ongoing OAC (n = 9) at 12 months (P = .49). In contrast, hs-CRP in both subgroups remained constantly low at levels seen in healthy controls. The course of D-dimer was similar to sP-selectin. Color duplex sonography showed no ongoing thrombus formation in any patient. Thirty-four (77.3%), 29 (65.9%), 26 (59.1%), and 25 (56.8%) patients had residual thrombosis 1, 3, 6, and 12 months after the acute event, respectively. D-dimer was significantly higher in patients with residual thrombosis compared with patients without residual thrombosis 1 month after DVT (0.58 μg/mL [range, 0.2-9.67 μg/mL] vs 0.25 μg/mL [range, 0.2-0.62 μg/mL]; P = .02). At all other time points, the levels of D-dimer and sP-selectin did not differ significantly between patients without and with residual thrombosis (all P > .05).
Concentrations of sP-selectin and D-dimer after acute DVT seem to be strongly influenced by treatment with vitamin K antagonists. After withdrawal of oral anticoagulation, they rise again and could therefore reflect a prothrombotic state, which is susceptible to pharmacologic therapy.
可溶性 P-选择素（sP-选择素）、D-二聚体和 C 反应蛋白（CRP）在深静脉血栓形成（DVT）中升高，并且可能作为复发性静脉血栓栓塞的风险预测因子发挥作用。然而，迄今为止，这些参数仅在表现时或 DVT 后单一时间点进行了评估。因此，我们研究了下肢急性非诱发性 DVT 后 sP-选择素、D-二聚体和高敏（hs）-CRP 的过程。
在这项前瞻性、纵向研究中，通过酶联免疫吸附试验、定量乳胶测定法和颗粒增强免疫比浊法，分别在 44 例经超声证实的急性 DVT 患者诊断时以及 1、3、6 和 12 个月后测定 sP-选择素、D-二聚体和 hs-CRP。sP-选择素和 hs-CRP 也在 88 名年龄和性别匹配的健康对照组中进行了测量。此外，所有患者在每个时间点均进行彩色双功超声检查。
在 DVT 诊断时，sP-选择素和 hs-CRP 在患者中明显高于健康对照组。从基线到 1 个月，这两个参数均显著下降。在接受口服抗凝治疗 6 个月的患者（n=35）中，抗凝治疗停止后 sP-选择素水平显著升高（P=.002），而在继续接受口服抗凝治疗的患者（n=9）中，sP-选择素在 12 个月时与健康对照组相似（P=.49）。相比之下，hs-CRP 在两个亚组中均保持在健康对照组的低水平。D-二聚体的过程与 sP-选择素相似。彩色双功超声显示任何患者均无持续的血栓形成。34（77.3%）、29（65.9%）、26（59.1%）和 25（56.8%）例患者在急性事件后 1、3、6 和 12 个月分别有残留血栓形成。与无残留血栓形成的患者相比，1 个月时有残留血栓形成的患者 D-二聚体显著升高（0.58μg/mL[范围，0.2-9.67μg/mL]与 0.25μg/mL[范围，0.2-0.62μg/mL]；P=.02）。在所有其他时间点，无残留血栓形成的患者与有残留血栓形成的患者的 D-二聚体和 sP-选择素水平无显著差异（均 P＞.05）。
急性 DVT 后 sP-选择素和 D-二聚体的浓度似乎受到维生素 K 拮抗剂治疗的强烈影响。口服抗凝治疗停药后，它们再次升高，因此可能反映了一种易受药物治疗影响的血栓形成状态。
