人工关节置换的类风湿关节炎患者D-dimer水平的临床意义

Clinical significance of D-dimer in recipients of total joint arthroplasty for rheumatoid arthritis

目的研究D-二聚体(D-dimer)在类风湿关节炎(RA)患者中的水平,探讨D-dimer术前水平对人工关节置换术后深静脉血栓(DVT)发生的临床意义。方法选择2004年12月至2005年11月行关节置换的109例患者,其中RA 52例,骨性关节炎(OA)41例和强直性脊柱炎(AS)16例;其中RA患者根据类风湿因子(RF)血清浓度,分为RF(-)组及RF(+)组。所有患者进行纤溶、凝血、血常规及炎性相关指标检测,进行统计学分析。结果RA患者血浆中的D-dimer均明显高于正常值,并明显高于OA、AS(P<0.01)。15例RA患者RF定量检查在正常范围,即RF(-),但D-dimer血浆浓度均值仍然增高,平均为(745±98)ng/ml,与OA、AS差异有统计学意义(P<0.01)。D-dimer与RF、C-反应蛋白(CRP)等炎性指标有密切相关性(P<0.01)。结论RA患者存在与OA、AS明显不同的纤维蛋白溶解。D-dimer在RA中存在明显增高的规律,因此RA患者D-dimer水平增高,不能作为DVT发生可能性大的可靠依据,也不能以此项增高而增大术后抗凝药剂量的指标。

Objective To characterize the level of D-dimer in rheumatoid arthritis （RA） patients and to identify the clinical significance of presurgieal D-dimer in prevention of deep vein thrombosis （DVT） after total joint arthroplasty. Methods Data on 109 recipients of total joint arthroplasty between December 2004 and November 2005, who presented with complete records of laboratory tests, were retrospectively analyzed. These patients comprised 52 eases of RA, 41 of osteoarthritis （OA） and 16 of ankylosing spondylitis （AS）. The RA patients were subdivided into rheumatoid factors （RF） positive group and RF negative group. The outcomes of laboratory test for all patients were statistically analyzed regarding the coagulation, fibrinolysis and inflammatory factors. Results The plasma level of D-dimer in RA patients was significantly higher than normal, also higher than those of OA and AS patients （P〈0.01）. The mean level of D-dimer in all RF-negative patients was （745±98）ng/ml, which was still higher than those of OA and AS patients （P〈0.01）. There was a strong correlation between D-dimer and other inflammatory factors such as RF and C-reactive protein （P〈0.01）. Conclusion Fibrinolysis in RA may show different profiles from those as found for OA and AS. High level of D-dimer can be frequently found in RA and therefore may not be reliable as a predictor of DVT and post-surgical intensified antieoagulatory therapy in RA patients.