Laboratory for Thrombosis and Hemostasis, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
J Thromb Haemost. 2012 Aug;10(8):1532-8. doi: 10.1111/j.1538-7836.2012.04798.x.
Post-thrombotic syndrome (PTS) occurs in 20-50% of patients after a deep venous thrombosis (DVT). It is difficult to accurately predict which patients will develop PTS. Biomarkers could be a valuable tool for PTS risk assessment.
To investigate whether increased levels of factor (F)VIII, C-reactive protein (CRP) or D-dimer, over time, are associated with the development of PTS in patients after an acute DVT.
PTS status was assessed using the Villalta scale. Blood sampling was performed at three points during follow-up.
A cohort of 228 consecutive patients was included after an acute DVT. At T1 (12 months after index DVT), both levels of D-dimer (median 725 ng mL(-1) [interquartile range, IQR 400-1400[ vs. 378 ng mL(-1) [251-652] P=0.004) and CRP (median 3.9 mg L(-1) [IQR 1.6-8.5] vs. 2.4 mg L(-1) [1.0-4.3] P=0.018) were increased in patients with PTS, compared with patients without PTS. Factor (F)VIII was not associated with PTS. In the multivariate logistic regression analysis, varicosities (odds ratio [OR] 13.4 95% confidence interval [CI] 3.0-59.1 P=0.001), a previous ipsilateral DVT (OR 6.3 95% CI 1.5-26.9 P=0.012) and CRP>5 mg L(-1) on T1 (OR 8.0 95% CI 2.4-26.4 P=0.001) were significantly associated with PTS.
Besides previous ipsilateral DVT and varicosities, CRP>5 mg L(-1) at T1 was strongly and independently associated with PTS. Persistent inflammation rather than hypercoagulability might be the most important etiological factor in PTS, and may be a target for future therapy. The development of a risk score for PTS, including both clinical risk factors and biomarker levels, such as CRP, might be desirable.
深静脉血栓形成（DVT）后，20-50%的患者会发生血栓后综合征（PTS）。很难准确预测哪些患者会发生 PTS。生物标志物可能是 PTS 风险评估的有用工具。
探讨 DVT 后患者随着时间的推移，因子 VIII（F）、C 反应蛋白（CRP）或 D-二聚体水平升高是否与 PTS 的发生有关。
采用 Villalta 量表评估 PTS 状态。在随访期间进行三次采血。
纳入了 228 例急性 DVT 后的连续患者。在 T1 （DVT 后 12 个月）时，PTS 患者的 D-二聚体水平（中位数 725ng/ml[四分位距 IQR 400-1400[）和 CRP 水平（中位数 3.9mg/L[IQR 1.6-8.5]）均高于无 PTS 患者（分别为 378ng/ml[IQR 251-652]和 2.4mg/L[IQR 1.0-4.3]，P=0.004 和 P=0.018）。F 因子（F）VIII 与 PTS 无关。在多变量逻辑回归分析中，静脉曲张（比值比[OR]13.4，95%置信区间[CI]3.0-59.1，P=0.001）、同侧 DVT 病史（OR 6.3，95%CI 1.5-26.9，P=0.012）和 T1 时 CRP>5mg/L（OR 8.0，95%CI 2.4-26.4，P=0.001）与 PTS 显著相关。
除了同侧 DVT 和静脉曲张外，T1 时 CRP>5mg/L 与 PTS 强烈且独立相关。持续性炎症而不是高凝状态可能是 PTS 的最重要病因，可能是未来治疗的靶点。包括临床危险因素和 CRP 等生物标志物水平在内的 PTS 风险评分的开发可能是可取的。
