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Clin Chem

类风湿因子增高的个体易患深静脉血栓

晋川

类风湿因子(RF)是类风湿性关节炎(RA)诊断中最为常用的标记物,约70%的RA患者显示RF增高。已有研究表明,RA患者的RF与炎症指标等呈正相关,因此RF还可以作为RA疾病活动度评价标志物。

大规模流行病学调查结果表明,RA患者发生静脉血栓的风险要高于健康个体,其原因在于RA患者体内持续的炎症反应。尽管炎症反应在静脉血栓发生与发展中的具体机制尚不明确,但已有确凿的证据表明炎症指标增高的个体患血栓性疾病的风险增高。

已知在普通人群中,约有5%-15%的个体RF增高。那么,这些RF增高但并未患RA的个体发生血栓的风险是否也较高呢?2015年2月发表在Clinical Chemistry上的一项来自丹麦的研究为我们揭示了答案。

该研究是一项大规模、基于普通人群的前瞻性队列研究,总共纳入了来自两个队列研究(哥本哈根城心脏研究和哥本哈根普通人群研究)的54628名普通人群,并对这些人进行了最长达32年的随访,用以分析基线RF水平与静脉血栓风险是否相关。

在随访期间内,共有670名个体发生了深静脉血栓(DVT),539名个体发生了肺栓塞(PE)。通过统计学分析后研究者发现,RF大于100 IU/ml的个体,1年和5年内发生DVT的风险分别是RF小于100 IU/ml的个体的9倍和4.3倍。进一步按照基线RF水平将患者分为5组后,研究者发现随着RF水平的增高,患者发生DVT的风险具有逐渐增高的趋势。

该研究同时也指出,RF水平增高与PE的发生风险无关。此外,在亚组分析中,研究者还发现对于体重指数(BMI)大于30 kg/m2且年龄在60岁以上的人群中,若RF高于120IU/ml,则男性和女性发生DVT的风险分别为10%和8%;与之对应的是,若RF低于15 IU/ml,男性和女性发生DVT的风险则仅为2.2%和1.6%。

该研究结果提示我们,对于RF增高的个体,即使其未患RA,也应该警惕DVT的发生,尤其是对于年龄在60周岁以上、BMI在30 kg/m2以上且RF在120 IU/ml以上的个体。

原文信息:
Increased rheumatoid factor and deep venous thrombosis: 2 cohort studies of 54628 individuals from the general population
Clin Chem. 2015 Feb;61(2):349-59. doi: 10.1373/clinchem.2014.233296. Epub 2014 Oct 2.
BACKGROUND: The risk of deep venous thrombosis is increased in patients with rheumatoid arthritis. We tested the hypothesis that increased concentrations of rheumatoid factor are associated with increased risk of deep venous thrombosis in individuals without autoimmune rheumatic disease in the general population. METHODS: We included 54628 participants from the Copenhagen City Heart Study (1981-83) and the Copenhagen General Population Study (2004-12), all with a measured concentration of IgM rheumatoid factor and without autoimmune rheumatic disease or venous thromboembolism. The main outcome was incident deep venous thrombosis. There were no losses to follow-up. RESULTS: During 368381 person-years, 670 individuals developed deep venous thrombosis. A rheumatoid factor concentration >/= vs <110 IU/mL showed the strongest association with deep venous thrombosis, with multivariable adjusted hazard ratios of 9.0 (95% CI 3.1-26) for 1-year follow-up, 4.3 (2.2-8.5) for 5-year follow-up, and 3.1 (1.7-5.6) for up to 32 years of follow-up. Compared with rheumatoid factor concentrations <15 IU/mL, the multivariable adjusted hazard ratios for deep venous thrombosis during maximum follow-up were 1.3 (1.0-1.5) for 15-29 IU/mL, 1.7 (1.0-2.8) for 30-59 IU/mL, 2.4 (1.3-4.3) for 60-119 IU/mL, and 3.0 (1.6-5.6) for >/=120 IU/mL (trend P = 6 x 10(-7)). Results were similar in the 2 studies separately. Obese men and women age >60 years with rheumatoid factor concentrations >/=120 IU/mL had 10% and 8% 5-year risk of deep venous thrombosis. CONCLUSIONS: Increased rheumatoid factor in the general population was associated with up to 3-fold increased long-term risk and up to 9-fold increased 1-year risk of deep venous thrombosis.

原文链接:http://www.clinchem.org/content/61/2/349.long


 

主办:医学研究与发表编辑部
赞助:美捷登生物科技有限公司

出版:华誉出版社有限公司

主编:夏华向
执行主编:张媛媛
编委会成员:段 柳 易 琴 李玉冰

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