Sato N, Takahashi H, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Am J Hematol. 1995 Mar;48(3):168-74. doi: 10.1002/ajh.2830480306.
In clinical practice, occasionally some patients show dissociated values of fibrinogen/fibrin degradation products (FDP) and D-dimer (cross-linked fibrin degradation products). In an attempt to assess the frequency, clinical backgrounds, and hemostatic states of these cases, FDP and D-dimer were simultaneously measured together with other hemostatic parameters in 371 samples from patients with various diseases. As a whole, FDP were elevated in parallel with the progress of activation of blood coagulation and fibrinolysis. However, in patients with elevated FDP and/or D-dimer, 11.5% of samples showed relatively lower D-dimer values than those expected from FDP levels, and these were regarded as an apparently dissociated group. In the dissociated group, activation of coagulation and fibrinolysis occurred to a lesser extent than others. Analysis of these samples suggested that the possible reasons for the dissociation between FDP and D-dimer values were accelerated fibrinogenolysis with or without secondary fibrinolysis, accelerated fibrinogenolysis by non-plasmic proteinases, elevated soluble fibrin, and possibly false-positive FDP levels due to unclottable fibrinogen remaining in the serum samples. In practice, simultaneous measurements of FDP and D-dimer are useful for more accurate estimation of hyperfibrinolytic states.
在临床实践中，偶尔会有一些患者的纤维蛋白原/纤维蛋白降解产物（FDP）和D - 二聚体（交联纤维蛋白降解产物）出现分离值。为了评估这些病例的发生频率、临床背景和止血状态，我们对371例患有各种疾病患者的样本同时检测了FDP、D - 二聚体以及其他止血参数。总体而言，FDP随着凝血和纤溶激活的进展而升高。然而，在FDP和/或D - 二聚体升高的患者中，11.5%的样本显示D - 二聚体值相对低于根据FDP水平预期的值，这些样本被视为明显分离组。在分离组中，凝血和纤溶的激活程度低于其他组。对这些样本的分析表明，FDP和D - 二聚体值分离的可能原因是伴有或不伴有继发性纤溶的纤维蛋白原溶解加速、非血浆蛋白酶引起的纤维蛋白原溶解加速、可溶性纤维蛋白升高以及血清样本中残留的不可凝纤维蛋白原可能导致FDP水平假阳性。在实际应用中，同时检测FDP和D - 二聚体有助于更准确地评估高纤溶状态。
