Fibrin fragment D-dimer and the risk of future venous thrombosis
Fibrin fragment D-dimer and the risk of future venous thrombosis
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DOI：
10.1182/blood-2002-05-1416
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发表时间：
2003-02-15
期刊：
影响因子：
20.3
通讯作者：
Heckbert, SR
中科院分区：
文献类型：
--
作者：
Cushman, M;Folsom, AR;Heckbert, SR
急性深静脉血栓形成期间，血浆 D-二聚体浓度升高超过 100 倍，但没有关于 D-二聚体作为一般人群中静脉血栓形成危险因素的前瞻性数据。静脉血栓形成是在两项前瞻性观察性研究（社区动脉粥样硬化风险研究和心血管健康研究）中确定的。在 1987 年至 1993 年间招募的 21 690 名参与者中，经过 8 年的随访，使用 307 名发生静脉血栓形成的参与者和 616 名未发生静脉血栓的参与者的基线储存血浆测量了 D-二聚体。相对于 D-二聚体分布的第一个五分位，D-二聚体第二至第五个五分位的未来静脉血栓形成的年龄调整比值比分别为 1.6、2.3、2.3 和 4.2（趋势 P < 0.0001）。对性别、种族、体重指数、因子 V Leiden、凝血酶原 20210A 和因子 VIII 凝血活性升高（因子 VIII:c）进行额外调整后，这些比值比分别为 1.5、2.1、1.9 和 3.0（趋势 P < .0001）。在患有特发性血栓或与癌症无关的继发性血栓的患者中，调整后的第五五分位比值比分别为 3.5 和 4.8。相比之下，第五与第一五分位数中的 D-二聚体与癌症相关血栓形成的发生无关（比值比，1.11）。在按年龄、性别、种族、随访时间和血栓类型（深静脉血栓或肺栓塞）定义的亚组中，D-二聚体升高的优势比持续升高。 D-二聚体与未来静脉血栓的发生呈强正相关。 (C) 2003 年，美国血液学会。
Plasma D-dimer concentration rises more than 100-fold during acute deep vein thrombosis, but there are no prospective data concerning D-dimer as a risk factor for incident venous thrombosis in a general population. Incident venous thrombosis was ascertained in 2 prospective observational studies, the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Of 21 690 participants enrolled between 1987 and 1993, after 8 years of follow-up, D-dimer was measured using baseline stored plasma of 307 participants who developed venous thrombosis and 616 who did not. Relative to the first quintile of the distribution of D-dimer, the age-adjusted odds ratios for future venous thrombosis for the second to fifth quintiles of D-dimer were 1.6, 2.3, 2.3, and 4.2, respectively (P for trend < .0001). Following added adjustment for sex, race, body mass index, factor V Leiden, prothrombin 20210A, and elevated factor VIII coagulant activity (factor VIII:c), these odds ratios were 1.5, 2.1, 1.9, and 3.0, respectively (P for trend < .0001). Among those with idiopathic thrombosis or secondary thrombosis unrelated to cancer, the adjusted fifth quintile odds ratios were 3.5 and 4.8, respectively. By contrast, D-dimer in the fifth versus first quintile was not related to occurrence of cancer-associated thrombosis (odds ratio, 1.11). Odds ratios for elevated D-dimer were consistently elevated in subgroups defined by age, sex, race, duration of follow-up, and thrombosis type (deep vein thrombosis or pulmonary embolus). D-dimer is strongly and positively related to the occurrence of future venous thrombosis. (C) 2003 by The American Society of Hematology.