老年人血浆D-二聚体增高相关因素研究

Correlation factors of plasma elevated D-dimer level in elderly people

目的从凝血系统、纤溶系统及血管内皮系统的角度,分析影响老年人D-二聚体增高的相关因素。方法研究对象为2011年3～11月海军总医院体检或门诊就诊老年人群。符合标准的有132例老年人,年龄60～91岁,男:女=68:64。根据D-二聚体检测结果(D-二聚体参考区间0～232ng/mL)将研究对象分为增高组和正常组。记录临床资料及病史;检测凝血系统、纤溶系统及血管内皮因子等相关指标。统计学分析:两组计量资料采用t检验和非参数检验,计数资料采用χ2检验;偏相关分析变量间关系。结果增高组与正常组比较年龄、纤维蛋白原、血管性血友病因子抗原和血栓调节蛋白水平增高,差异均有统计学意义(P值分别为0.000、0.001、0.000和0.008),增高级珠以上指标均高于正常组。固定变量年龄,DD水平的对数值与血管性血友病因子抗原、血栓调节蛋白和纤维蛋白原水平的偏相关系数分别为0.450(P=0.001)、0.301(P=0.025)和0.187(P=0.034),相关关系显著,且密切程度递减,即DD水平的对数值与反映血管内皮受损的指标(血管性血友病因子抗原和血栓调节蛋白)的密切程度强于DD水平的对数值与反映凝血的指标(纤维蛋白原)。结论老年人D-二聚体水平随年龄增高而升高可能与血管内皮受损有关。

Objective To discuss the reasons of high level of plasma D-dimer in elderly people from three aspects：coagulation, fi- brinolysis and endothelial system. Methods The objects of study were from physical examination or outpatient encounter in Navy General Hospital from March 2011 to November 2011. A total of 132 persons were deemed eligible to participate,age 60--91 y, male ： female= 68 ： 64. According to the laboratory reference range（0--232 ng/mL）, two groups were divided, namely the high lev- el group and the normal level group. Clinical data and history had been registered in detail. Coagulation,fibrinolysis and endothelial system were detected. Statistical analysis：measurement data were compared between two groups using t-test if the distribution was normal. If not,using rank-sum test. Enumeration data were explored between two groups using the chi-squared test. Partial correla-tion was used to evaluate associations between logDl） and variable. Results The levels of age,fibrinogen,von Willehrand factor an tigen and thrombomodulin between two groups were different（P=0. 000,0. 001,0. 000 and 0. 008, respectively）. In all, the abow： mentioned parameters were higher in the high level group than in the normal level group. After adjustment for age,partial correla tion analysis was significantly different respectively between IogDl） and von Willebrand factor antigen,thrombomodulin, fibrinogen. The partial correlation coefficient were 0. 450,0. 301 and 0. 187（P：0. 001,0. 025,0. 034,respectively） ,and the degree decreased. The associalion between logl）D and the markers of endothelial dysfunction （von Willebrand factor antigen and thrombomodulm） were better than logDD and the parameters of eoagulation（fibrinogen）. Conclusion It may concludes that endothelial dysfunetion is the reason of elevated level of D-dimer in elderly people.