Chauhan Shailja, Mahajan Vikram K, Mehta Karaninder S, Yadav Rajinder S, Chauhan Pushpinder S, Bhushan Satya, Sharma Vikas, Sharma Anuj, Wadhwa Dhaarna, Sharma Aditi
Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India.
Department of Biochemistry, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India.
Indian Dermatol Online J. 2019 Nov 1;10(6):632-638. doi: 10.4103/idoj.IDOJ_505_18. eCollection 2019 Nov-Dec.
Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome.
Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels.
Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16-42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels.
A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.
活化的凝血级联反应与荨麻疹的发病机制有关，其特征是血浆D - 二聚体水平升高，D - 二聚体是纤维蛋白溶解的标志物，其水平与高荨麻疹活动评分（UAS）及不良治疗结果相关。
比较了100名（男女比例为1:3）印度慢性自发性荨麻疹患者和年龄及性别匹配的健康对照者的血浆D - 二聚体定量水平及凝血参数。然后比较了血浆D - 二聚体水平正常（≤0.2 mg/L）和升高（≥0.3 mg/L）的慢性荨麻疹患者的临床流行病学特征。
分别有23%的患者和4%的对照者血浆D - 二聚体水平显著升高，分别有63%的患者和5%的对照者凝血酶原时间及活化部分凝血活酶时间显著延长。在72名UAS≥16 - 42的高评分患者中，约18名（25%）与28名UAS≤15的患者中的5名（17.8%）进行了比较。血浆D - 二聚体水平升高的患者比血浆D - 二聚体水平正常的患者有更多的全身症状（86.9%对81.8%）。
一部分慢性荨麻疹患者血浆D - 二聚体水平升高，表现出更高的UAS7及全身症状，这可能影响长期预后和治疗选择。本研究的局限性包括患者数量少、研究的横断面性质、缺乏治疗结果测量、自我用药信息以及无法获得凝血途径激活的特定参数。
