D-二聚体在类风湿关节炎中的临床意义

目的探讨D-二聚体在类风湿关节炎(RA)中的临床意义。方法纳入RA患者134例(RA组),同时纳入健康体检者(健康对照组)、系统性红斑狼疮(SLE,SLE组)及原发性干燥综合征(PSS,PSS组)患者各30例。依据28个关节的疾病活动度评分(DAS28),将RA患者分为缓解组(DAS28<2.6)、低疾病活动组(2.6≤DAS28<3.2)、中疾病活动组(3.2≤DAS28≤5.1)及高疾病活动组(DAS28>5.1)。检测各组受试者血浆D-二聚体水平并进行比较,采用Pearson相关分析和多因素logistic回归分析评估RA患者D-二聚体与其他指标之间的相关性。结果RA组受试者D-二聚体水平明显高于健康对照组、SLE组、PSS组(P<0.01)。不同疾病活动组RA患者D-二聚体水平比较差异有统计学意义(P<0.01),其中缓解组低于3个疾病活动组,低疾病活动组和中疾病活动组均低于高疾病活动组(P<0.01)。Pearson相关分析结果显示,RA患者D-二聚体与年龄、PLT计数、红细胞沉降率、C反应蛋白、DAS28、凝血酶原时间、纤维蛋白降解产物、纤维蛋白原水平均呈正相关,与血红蛋白呈负相关(P<0.01)。多因素logistic回归分析,结果显示,DAS28、纤维蛋白降解产物水平升高是RA患者D-二聚体水平升高的危险因素(P<0.01)。结论RA患者D-二聚体水平可较好地反映疾病活动度,对判断预后具有意义,可作为评价RA病情活动性的参考指标之一。

Clinical significance of D-dimer in rheumatoid arthritis

Objective To explore the clinical significance of D-dimer in rheumatoid arthritis(RA).Methods A total of 134 patients with RA were concluded.At the same time,healthy checkers(healthy control group),systemic lupus erythematosus(SLE,SLE group)and primary Sjogren’s syndrome(PSS,PSS group)patients were included,with 30 subjects in each group.According to disease activity score of 28 joints(DAS28),RA patients were divided into remission group(DAS28<2.6),low disease activity group(2.6≤DAS28<3.2),moderate disease activity group(3.2≤DAS28≤5.1),high disease activity group(DAS28>5.1).Plasma D-dimer levels in each group were detected and compared.Pearson correlation analysis and multivariate logistic regression analysis were used to assess the correlation between D-dimer and other indexes in RA patients.Results D-dimer level in RA group was significantly higher than those in healthy control group,SLE group and PSS group(P<0.01).D-dimer levels of RA patients in different disease activity groups were statistically significant(P<0.01).D-dimer level in remission group was lower than those in 3 disease active groups,those in low disease activity group and in middle disease activity group were lower than that in high disease activity group(P<0.01).Pearson correlation analysis showed that D-dimer in RA patients was positively correlated with age,PLT count,erythrocyte sedimentation rate,C-reactive protein,DAS28,prothrombin time,fibrin degradation products,fibrinogen levels,and was negatively correlated with hemoglobin(P<0.01).Multivariate logistic regression analysis showed that elevated DAS28 and fibrin degradation products were risk factors for elevated D-dimer levels in RA patients(P<0.01).Conclusion D-dimer level in patients with RA can reflect disease activity,and it is of significance for judging prognosis,which can be used as one of the reference index for evaluating disease activity of RA.