D-Dimer Level and the Risk for Thrombosis in Systemic Lupus Erythematosus

作者：Wu Haifeng; Birmingham Daniel J; Rovin Brad; Hackshaw Kevin V; Haddad Nabil; Haden Douglas; Yu Chack Yung; Hebert Lee A^*

来源：Clinical Journal of the American Society of Nephrology, 2008, 3(6): 1628-1636.

DOI：10.2215/CJN.01480308

Background and objectives: Patients who have systemic lupus erythematosus (SLE) and manifest antiphospholipid antibodies (APA) are at increased risk for thrombosis; however, it is difficult to predict who will clot. This study tested the hypothesis that peak D-dimer level measured routinely during follow-up identifies whether a hypercoagulable state is developing and, therefore, the patient is at increased risk for thrombosis.
Design, setting, participants, & measurements: One hundred consecutive patients who had SLE with recurrent activity (71%) renal SLE) and were evaluated for or enrolled in the Ohio SLE Study were studied. D-dimer testing was done annually and usually at SLE flare or other serious illness. When D-dimer was elevated, evaluation for thrombosis (large vessel, small vessel, or Libman-Sacks) was undertaken. Mean follow-up was 37.5 +/- 15 SD months.
Results: Of those with peak D-climer 0.5 mu g/ml (n = 46), 0% thrombosed, 33% had APA. Of those with peak D-climer 0.5 to 2.0 mu g/ml (n = 19), 6% thrombosed, 44%, had APA. Of those with peak D-dimer >2.0 mu g/ml (n = 36), 42% thrombosed, 76% had APA. The most common causes of elevated D-dimer in the absence of demonstrable thrombosis were SLE flare and systemic infection. D-dimer levels were usually elevated for several months before thrombosis.
Conclusions: Patients with SLE and normal D-dimer levels are at low risk for thrombosis, irrespective of APA status. Those with persistent unexplained elevated D-dimer levels, particularly when >2.0 mu g/ml, are at high risk for thrombosis.

• 出版日期2008-11