门诊类风湿关节炎患者血浆 D-二聚体升高的主要决定因素是临床疾病活动度：一项基于医院的横断面研究。

Clinical disease activity is a major determinant of plasma D-dimer elevation in outpatients with rheumatoid arthritis: A hospital-based cross-sectional study.

机构信息

Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan.

Department of Cardiovascular Medicine, Graduate School of Medical Sciences and Health Care Center, Kumamoto University, Kumamoto, Japan.

出版信息

Mod Rheumatol. 2024 Feb 26;34(2):313-321. doi: 10.1093/mr/road018.

DOI:10.1093/mr/road018

PMID:36726243

Abstract

OBJECTIVES

To identify factors associated with plasma D-dimer levels in outpatients with rheumatoid arthritis (RA).

METHODS

We consecutively recruited 460 RA patients who visited our hospital for routine follow-ups between June and October 2021. Plasma D-dimer, RA-related characteristics, comorbidities, and cardiovascular and venous thromboembolism (VTE) risk factors were examined at enrolment. Patients with elevated D-dimer levels underwent whole-leg venous ultrasonography to diagnose deep vein thrombosis (DVT).

RESULTS

Participants had no DVT signs or symptoms. Among them, 252 (54.8%) were positive for plasma D-dimer (≥0.5 μg/ml) and 40 (8.7%) had high D-dimer levels (≥3 μg/ml). The mean was 1.07 μg/ml. After adjustments, age [odds ratio (OR) 1.88 per additional 10 years, P = .003], high and moderate clinical disease activity index (OR 8.79, P < .001), and the presence of comorbidities or cardiovascular/VTE risk factors (OR 2.94, P = .017) were identified as the factors independently associated with high D-dimer levels. Among patients with D-dimer levels ≥3 μg/ml, 10 (25%) had DVT in their lower limbs, and D-dimer levels were significantly higher in patients with DVT compared with those without it (mean 6.0 vs. 4.1 μg/ml, P < .001).

CONCLUSIONS

Clinical disease activity is a major contributor to plasma D-dimer elevation in RA outpatients.

摘要

目的

确定与门诊类风湿关节炎（RA）患者血浆 D-二聚体水平相关的因素。

方法

我们连续招募了 2021 年 6 月至 10 月期间来我院常规随访的 460 例 RA 患者。在入组时检查了血浆 D-二聚体、与 RA 相关的特征、合并症以及心血管和静脉血栓栓塞（VTE）危险因素。D-二聚体水平升高的患者行下肢静脉超声检查以诊断深静脉血栓形成（DVT）。

结果

参与者无 DVT 体征或症状。其中，252 例（54.8%）血浆 D-二聚体阳性（≥0.5μg/ml），40 例（8.7%）D-二聚体水平较高（≥3μg/ml），平均值为 1.07μg/ml。经调整后，年龄[每增加 10 岁的优势比（OR）为 1.88，P=0.003]、高和中度临床疾病活动指数（OR 8.79，P<0.001）以及合并症或心血管/VTE 危险因素的存在（OR 2.94，P=0.017）被确定为与高 D-二聚体水平相关的独立因素。在 D-二聚体水平≥3μg/ml 的患者中，有 10 例（25%）下肢存在 DVT，DVT 患者的 D-二聚体水平明显高于无 DVT 患者（平均 6.0μg/ml 比 4.1μg/ml，P<0.001）。