|摘要||目的 检测类风湿关节炎(RA)患者血中D-二聚体水平,探讨其在RA中的临床意义.方法 本研究纳入RA患者58例,疾病对照组患者64例(包括系统性红斑狼疮18例、血清阴性脊柱关节病15例、骨关节炎11例、其他结缔组织病20例).所有患者均排除血栓性疾病,近6个月无手术、外伤和肿瘤病史.记录患者的临床和实验室指标,采用免疫比浊法检测血中D-二聚体水平.并研究其与RA患者疾病活动度(DAS28评分)、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)等指标的关系.采用Mann-Whitney U检验、t检验及Spearman相关分析.结果 ①RA患者血D-二聚体增高的比例明显高于疾病对照组(分别为82.6%和21.9%,P＜0.01).血D-二聚体水平在RA患者中明显高于对照组[分别为(1.76±1.57)和(0.32±0.25)mg/L,P＜0.01].②在RA患者中,D-二聚体增高组DAS28水平高于D-二聚体正常组(5.4±1.0和4.4:±0.8,P＜0.01).D-二聚体增高组RA患者的ESR、CRP和RF水平均高于D-二聚体水平正常组RA患者[分别为(58±29)和(28±13)mm/1 h;(39±36)和(11±9)mg/L;(409±718)和(46±40)U/ml,P均＜0.05].③相关性分析显示,D-二聚体水平与DAS28评分(r=0.406,P＜0.01)、ESR(r=0.355,P＜0.01)和RF(r=0.319,P＜0.05)具有相关性.结论 RA患者血D-二聚体水平较其他风湿病患者明显升高,且与病情活动度密切相关.提示凝血-纤溶系统激活可能在RA的病情发展和病理过程中发挥作用.
Objective To detect D-Dimer in the blood of rheumatoid arthritis (RA) patients and to investigate its clinical significance in RA. Methods Blood samples were obtained from 58 patients with RA,18 patients with systemic lupus erythematosus (SLE), 15 patients with ankylosing spondylitis, 11 patients with osteoarthritis, and 20 patients with other connective tissue diseases. The presence of thrombotic diseases was excluded in all patients. The presence of D-Dimer in the blood was examined by immunoturbidimetry. The following clinical and laboratory data were collected: disease activity index DAS28, rheumatoid factor (RF),erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Mann-Whitney U test, t-test ,Spearman correlation were used for statistical analysis. Results ① The prevalence of high level D-Dimer in RA patients was higher than that of the control group (82.6％ vs 21.9％, P＜0.01). The titer of D-Dimer in RA was significantly higher than that of the control group [(1.76±1.57) vs (0.32±0.25) mg/L, P＜0.01]. ②DAS28 was higher in RA patients with positive D-Dimer than those with negative D-Dimer (5.4±1.0 vs 4.4±0.8,P＜0.01). The values of ESR, CRP and RF in RA patients with positive D-Dimer were significantly higher than those in patients with negative D-Dimer (P＜0.05). ③ There was positive correlation between D-Dimer and DAS28 (r=0.406, P＜0.05), ESR (r=0.355, P＜0.01), and RF (r=0.319, P＜0.05). Conclusion The level of D-Dimer in the blood of RA patients is significantly higher than other rheumatic diseases, and is positively correlated with disease activities. The results indicated that the activation of coagulation-fibrinolytic systems may play a role in the pathogenesis of rheumatoid arthritis.|