D-dimer as a significant marker of deep vein thrombosis in patients with subclinical or overt Cushing's syndrome
D-dimer as a significant marker of deep vein thrombosis in patients with subclinical or overt Cushing's syndrome
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DOI：
10.1507/endocrj.ej14-0102
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发表时间：
2014-10-01
影响因子：
2
通讯作者：
Takahashi, Yutaka
中科院分区：
文献类型：
--
作者：
Fukuoka, Hidenori;Takeuchi, Takehito;Takahashi, Yutaka
静脉血栓栓塞（VTE）常与高皮质醇血症有关。这项回顾性单中心研究旨在阐明血浆D-二聚体水平对亚临床或明显库欣综合征（soCS）患者进行VTE筛查的意义。2002年至2014年期间，在科比大学医院确诊的连续72例未接受过治疗的soCS患者入组研究。研究1招募了同时具有下肢超声和D-二聚体测量数据的患者（n = 19），并分为2组，深静脉血栓形成（DVT）（-）组（n = 12）和深静脉血栓形成（+）组（n = 7）进行相关因素的比较。DVT（+）组的年龄和D-二聚体水平高于DVT（-）组（分别为p = 0.04和0.02）。受试者操作特征分析发现D-二聚体水平≥ 2.6 μ g/mL与DVT的存在相关（敏感性，100%;特异性，91.7%）。接下来，在研究2中招募了具有D-二聚体测量数据的患者（n = 36），并根据D-二聚体水平分为2组：D-二聚体（-），= 1 μ g/mL组（n = 13）;比较各组的各种VTE相关风险因素。Logistic回归分析显示，低剂量地塞米松抑制后皮质醇水平升高是D-二聚体升高的显著危险因素（OR = 1.21，p = 0.02）。总之，这些数据表明，D-二聚体水平≥ 2.6 μ g/mL是未接受过治疗的soCS患者DVT的指标，并表明相对较高的自主皮质醇分泌可能与血栓形成相关。
Venous thromboembolism (VTE) is frequently associated with hypercortisolemia. This retrospective single-center study aimed to clarify the significance of plasma D-dimer levels for VTE screening in patients with subclinical or overt Cushing's syndrome (soCS). A total of 72 consecutive treatment-naive patients with soCS diagnosed at Kobe University Hospital between 2002 and 2014 were enrolled. Patients with both lower extremity ultrasound and D-dimer measurement data (n = 19) were recruited in study 1 and divided into 2 groups, a deep vein thrombosis (DVT) (-) group (n = 12) and DVT (+) group (n = 7) for a comparison of the associated factors. The age and D-dimer levels were higher in the DVT (+) group than in the DVT (-) group (p = 0.04 and 0.02, respectively). A receiver operating characteristic analysis found that D-dimer level >= 2.6 mu g/mL correlated with the presence of DVT (sensitivity, 100%; specificity, 91.7%). Next, patients with D-dimer measurement data (n = 36) were recruited in study 2 and divided into 2 groups according to D-dimer level: D-dimer (-), = 1 mu g/mL group (n = 13); the groups were compared with respect to various VTE-related risk factors. A logistic regression analysis revealed that elevated cortisol level after low-dose dexamethasone suppression was a significant risk factor for D-dimer elevation (OR = 1.21, p = 0.02). In conclusion, these data demonstrate that a D-dimer level >= 2.6 mu g/mL is an indicator of DVT in treatment naive patients with soCS and suggests that relatively high autonomous cortisol secretion may be associated with thrombus formation.