摘要
目的探讨类风湿关节炎(RA)患者血浆D-二聚体(D-dimer)和纤维蛋白原(FIB)水平与疾病活动度及颈动脉粥样硬化(CAS)的相关性。方法选取2024年10~12月在四川省人民医院风湿免疫科门诊及住院治疗的103例RA患者,同期42例健康人群(对照组)。结合患者疾病活动度评分(DAS28)及颈动脉超声结果进行分组,分析D-dimer及FIB在不同疾病活动度RA患者中水平差异及其与各项临床指标相关性,同时探讨其与RA患者颈动脉粥样硬化的关系。结果RA患者组血浆D-dimer、FIB水平均高于健康对照组(P<0.01);在不同疾病活动度RA患者中,血浆D-dimer、FIB水平差异有统计学意义(P<0.05)。RA患者血浆D-dimer水平与DAS-28、红细胞沉降率(ESR)、C-反应蛋白(CRP)呈正相关(P<0.001),FIB水平与DAS-28、ESR、CRP、C3呈正相关(P<0.001)。根据颈动脉超声表现将RA患者分为NCAS组和CAS组,两组年龄、ESR、抗环瓜氨酸抗体(Anti-CCP)、D-dimer差异有统计学意义(P<0.05),CAS组年龄更大,ESR更快,Anti-CCP、D-dimer水平更高。Logistic回归分析结果显示,D-dimer为RA患者发生CAS的危险因素(P=0.032)。ROC曲线显示:Ddimer、FIB联合作为危险因素评估RA患者发生CAS的AUC为0.670(95%CI:0.563~0.777),敏感度为0.623,特异性为0.76。结论RA患者的血浆D-dimer和FIB可以在一定程度上反映疾病活动和炎症状态,监测这些指标有助于评估RA患者病情活动及动脉粥样硬化风险。
Objective To explore the relationship between the levels of plasma D-dimer and fibrinogen(FIB)and the disease activity and carotid atherosclerosis(CAS)in patients with rheumatoid arthritis(RA).Methods A total of 103 RA patients who were treated at the Department of Rheumatology and Immunology in Sichuan Provincial People′s Hospital from October to December 2024 were selected.At the same time,42 healthy individuals were chosen as a control group.The patients were grouped according to their disease activity score(DAS28)and carotid ultrasound results.The level differences of D-dimer and FIB in RA patients with different disease activities were analyzed.Their correlations with various clinical indicators were examined.In addition,the relationship between the D-dimer and FIB and the carotid atherosclerosis in RA patients was also explored.Results The plasma D-dimer and FIB levels in the RA patient group were significantly higher than those in the healthy control group(P<0.01).There was a statistically significant difference in plasma D-dimer and FIB levels among RA patients with different disease activity levels(P<0.05).The plasma D-dimer level in RA patients was positively correlated with DAS-28,erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)(P<0.001).The FIB level was positively correlated with DAS-28,ESR,CRP and C3(P<0.001).The RA patients were divided into a NCAS group and a CAS group according to carotid artery ultrasound performance.There were significant differences in age,ESR,anti-CCP and D-dimer between the two groups(P<0.05).The age was older,the ESR was faster,the levels of anti-CCP and D-dimer were higher in the CAS group than those in the NCAS group.The logistic regression results showed that D-dimer was a risk factor for CAS in RA patients(P=0.032).The ROC curve analysis showed that the AUC of D-dimer and FIB combined as risk factors for assessing the occurrence of CAS in RA patients was 0.670(95%CI:0.563~0.777).The sensitivity was 62.3%.The specificity was 76.0%.Conclusions The plasma D-dimer and FIB of RA patients can reflect the disease activity and inflammatory status to a certain extent.Monitoring these indicators is helpful to assess the disease activity and atherosclerosis risk of RA patients.
作者
王如意
郑晓玫
郑雅文
张唯
陈智慧
戴雨伶
龙丽
WANG Ru-yi;ZHENG Xiao-mei;ZHENG Yawen;ZHANG Wei;CHEN Zhi-hui;DAI Yu-ling;LONG Li(School of Clinical Medicine,Southwest Medical University,Luzhou 646000,China;Department of Rheumatology and Immunology,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital(Affiliated Hospital of University of Electronic Science and Technology of China),Chengdu 610072,China)
出处
《实用医院临床杂志》
2026年第2期95-100,共6页
Practical Journal of Clinical Medicine
基金
四川省科技厅科研基金资助项目(编号:2020JDRC0118)。
