自身免疫性疾病D-二聚体水平测定及其临床意义

目的:探讨检测D-二聚体在自身免疫性疾病(autoimmune disease,AID)患者中的临床意义。方法:收集AID患者血浆标本214例,按照美国风湿病学会分类标准对AID患者进行分类,其中类风湿性关节炎(RA)组77例,系统性红斑狼疮(SLE)组69例,特发性血小板减少性紫癜35例,全身性硬皮病15例,原发性干燥综合征18例。采用乳胶增强透射免疫比浊法测定血浆中D-二聚体水平,观察各类疾病不同活动度间及治疗前后D-二聚体水平差异,并结合血常规和生化各指标进行相关性分析。结果:RA组D-二聚体水平均高于与其他4类疾病(P<0.05~P<0.01);RA组和SLE组患者中高活动组D-二聚体水平均明显高于低活动组(P<0.01);RA组和SLE组患者治疗后D-二聚体水平均低于治疗前和治疗中(P<0.05~P<0.01);在RA组中,类风湿因子水平与D-二聚体水平呈正相关关系(P<0.01),在SLE组中,D-二聚体水平与尿酸水平呈正相关关系(P<0.01),与红细胞和血小板数量均呈负相关关系(P<0.01)。结论:在常见5类AID患者中,RA患者血浆D-二聚体水平增高最为明显,其次为SLE,且D-二聚体水平高低与疾病活动性和治疗阶段密切相关。提示RA和SLE患者的D-二聚体水平可作为临床判断病情活动度和治疗效果的参考指标之一。

The levels of plasma D-dimer in patients with autoimmune diseases and its clinical significance

Objective:To detect plasma D-dimer levels in patients with autoimmune diseases ( AID ) and study the clinical significance. Methods: The levels of plasma D-dimer in 214 patients with AID were detected by latex particle enhanced immunoturbidimetric assay. The AID patients were classified with Classfication Standard of American Rheumatism Association, 77 patients with rheumatoid arthritis ( RA ) , 69 patients with systemic lupus erythematosus ( SLE ) , 35 patients with idiopathic thrombocytopenic purpura,15 patients with systemic sclerosis and 18 patients with primary sjogren's syndrome were selected. The levels of plasma D-dimer were observed during the different activities of these diseases,before and after treatment,the correlations of D-dimer levels with blood routine and biochemical indexes were also analyzed. Results:Plasma D-dimer level in RA patients was significantly higher than that in the other 4 groups (P<0. 05 to P<0. 01). During the time of the disease with high activity,D-dimer levels in RA and SLE patients were both significantly higher than those of the disease with low activity(P<0. 01). After therapy,D-dimer levels in RA and SLE patients were significantly lower than that during and before therapy(P<0. 05 to P<0. 01). In RA group,the rheumatoid factor was positively correlated with the level of D-dimer(P<0. 01). In SLE group,D-dimer level was positively correlated with plasma uric acid level(P<0. 01),negatively correlated with the numbers of red blood cell and platelet(P<0. 01). Conclusions:In the five common type AID patients,the level of plasma D-dimer in RA patients was highest,following in SLE,and the level of D-dimer was closely associated with disease activity index and treatment phases. The findings suggested plasma D-dimer level may use as a clinical reference index of the disease activity and curative effectiveness in RA and SLE patients.