rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2005-1519rsp-1325Research ArticleСтатьиArticlesПоказатели свертываемости крови и индексы активности у больных системной красной волчанкойBlood coagulation parameters and activity indices in patients with systemic lupus erythematosusArshinovA. A.ArshinovA. A.-ShilkinaN PShilkinaN P-MasinaI. V.MasinaI. V.-DryazenkovaI. V.DryazenkovaI. V.-LevshinN YLevshinN Y-RedkoV VRedkoV V-200515042005432№2 (2005)2024Copyright © Arshinov A.A., Shilkina N.P., Masina I.V., Dryazenkova I.V., Levshin N.Y., Redko V.V., 20052005Arshinov A.A., Shilkina N.P., Masina I.V., Dryazenkova I.V., Levshin N.Y., Redko V.V.Arshinov A.A., Shilkina N.P., Masina I.V., Dryazenkova I.V., Levshin N.Y., Redko V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1325

Цель. Оценить показатели свертывания и индексы активности у больных системной красной волчанкой (СКВ). Материал и методы. Обследовано 86 больных СКВ (83 жен и 3 муж), 12 из них с АФС. Средний возраст 35,9+1,5 лет (от 18 до 58 лет), средняя длительность заболевания 9,8±1,4 лет. Контроль - 60 здоровых добровольцев, средний возраст 37,1+4,1 лет. Оценка активности СКВ производилась в соответствии с индексами SLAM, SLEDAI и ECLAM. Результаты. У больных СКВ определялось 5-кратное (р<0,01) увеличение спонтанной агрегации тромбоцитов и более чем Зх-кратное увеличение концентрации антигена фактора фон Виллебранда (ФВ:Аг). Активация тромбоцитов сочеталась со снижением агрегации тромбоцитов с коллагеном на 27% (р<0,01). Характерным признаком активации коагуляционного гемостаза было значительное увеличение - на 81% (р<0,01) - концентрации растворимых фибрин-мономерных комплексов (РФМК), а также повышение уровня Д-димеров у 53,3% больных. Концентрация фибриногена была повышена на 29%; показатели спонтанного фибринолиза снижены на 20%, активность антитромбина (AT) III уменьшена на 21% по сравнению с контролем. Выявлена прямая корреляционная связь между индексами активности и РФМК (ECLAM, г=0,51), концентрацией фибриногена (SLAM, г=0,34), уровнем Д-димеров (ECLAM, г=0,5), спонтанной агрегацией тромбоцитов (ECLAM, г=0,5) и обратная корреляция с активностью АТ III (SLEDAI, г=-0,73). Заключение. Изменение гемостазиологических показателей при СКВ может служить предиктором развития тромботических нарушений и показанием к медикаментозной коррекции нарушений свёртывающей системы крови. Показана прямая зависимость между напряженностью свёртывающей системы крови и индексами активности СКВ.

Objective. To assess coagulation parameters and activity indices in pts with systemic lupus erythematosus (SLE). Material and methods . 86 pts with SLE (83 female and 3 male) were examined. 12 of them had antiphospholipid syndrome. Mean age was 35,9±1,5 years (from 18 to 58 years), mean disease duration was 9,8+1,4 years. Control group consisted of 60 healthy volunteers with mean age 37,1+4,1 years. SLE activity assessment was performed with SLAM, SLEDAI and ECLAM indices. Results. SLE pts showed 5-fold (p<0,01) increase of spontaneous platelets aggregation and more than 3-fold increase of factor von Willebrand antigen (FWA) concentration. Platelet activation in pts was accompanied by decrease of platelet aggregation with collagen (on 27%), p<0,01. Characteristic sign of coagulation hemostasis activation was significant increase of soluble fibrin-monomer complexes (SFMC) concentration on 81 % (p<0,01) so as increase D-dimers level in 53,3% of pts. Fibrinogen concentration was increased on 29%, spontaneous fibrinolysis parameters were decreased on 20%, antithrombin (AT) 111 - on 21% in comparison with control. Direct correlation between activity indiccs and SFMC(ECLAM, r=0,5), fibrinogen concentration (SLAM, r=0,34), D- dimers level (ECLAM, r=0,5), spontaneous platelet aggregation (ECLAM, r=0,5) so as inverse correlation with AT III activity (SLEDAI, r-0,73) was revealed. Conclusion. Changes of hemostasis parameters in SLE may serve as predictors of thrombotic disorders development and indication to drug correction of blood coagulation disorders. Direct correlation between blood coagulation system activity and indices of SLE activity.

СКВиндексы активностиантитромбин IIIД-димеррастворимые фибрин-моно- мерные комплексыSLEantithrombin IIID-dimersoluble fibrin-monomer complexesactivity indicesReferences<div><p>Насонов Е.Л. Роль нарушений иммунитета и воспаления при ревматических заболеваниях. В кн.: В.А.Насоновой, Н.В.Бунчука, ред. Ревматические болезни. М., Медицина, 1997, 29-52</p><p>Dixit К., Ali R. Role of nitric oxide modified DNA in the etiopa.thogenesis of systemic lupus erythematosus. Lupus, 2004, 13(2), 95-100</p><p>Насонова B.A., Фоломеева O.M. Медико-социальное значение XIII класса болезней для населения России. Науч,- практ. ревматол., 2001, 1,7-11</p><p>Manger К., Manger В., Repp R. ct al. Definition of risk factors for death, end stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus. Ann. Rheum. Dis., 2002, 61(12), 1065-1070</p><p>Cervera R., Khamashta M.A., Font J. el al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore), 2003, 82(5), 299-308</p><p>Becker B.F., Heindl B., Kupatt C., Zahler S. Endothelial function and hemostasis. Z.Kardiol., 2000, 89(3), 160-167</p><p>Ekdahl K.N., Ronnblom L., Sturfelt G., Nilsson B. Increased phosphate content in complement component C3, fibrinogen, vitronectin, and other plasma proteins in systemic lupus erythematosus: covariation with platelet activation and possible association with thrombosis. Arthr. Rheum., 1997,40(12), 2178-2186</p><p>Rajagopalan S., Somers E.C., Brook R.D. et al. Endothelial cell apoptosis in systemic lupus erythematosus: a common pathway for abnormal vascular function and thrombosis propensity. Blood, 2004,-103(10), 3677-3683</p><p>Esmon C.T., Fukudome K., Mather T. et al. Inflammation, sepsis, and coagulation. Haematolog., 1999, 84(3), 254-259</p><p>Ekdahl K.N., Bengtsson A.A., Andersson J. et al. Thrombotic disease in systemic lupus erythematosus is associated with a maintained systemic platelet activation. Br. J. Haematol., 2004, 125(1), 74-78</p><p>Esmon C.T. Does inflammation contribute to thrombotic events? Haemostas., 2000, 30 (suppl. 2), 34-40</p><p>lnoh М., Tokuda М., Kiuchi H. et al. Evaluating systemic lupus erythematosus disease activity using molecular markers of hemostasis. Arthr. Rheum., 1996, 39(2), 287-291</p><p>Segal j., KicklerT., Petri M. Tissue factor activity in patients with systemic lupus erythematosus: association with disease activity. J. Rheumatol., 2000, 27(12), 2827-2832</p><p>Kiraz S., Ertcnli I., Benekli M. et al. Clinical significance of hemostatic markers and thrombomodulin in systemic lupus erythematosus: evidence for a prothrombotic state. Lupus, 1999, 8(9), 737-741</p><p>Amengual O., Atsumi Т., Khamashta M.A., Hughes G.R. The role of the tissue factor pathway in the hypercoagulable state in patients with the antiphospholipid syndrome. Thromb.Haemost., 1998, 79(2), 276-281</p><p>Gezer S. Antiphospholipid syndrome. Dis.Mon. 2003, 49(12), 696-741</p><p>Ames P.R., Alves J., Pap A.F., et al. Fibrinogen in systemic lupus erythematosus: more than an acute phase reactant? J. Rheumatol., 2000, 27(5), 1190-1195</p><p>Doria A., Ghirardello A., Boscaro M. et al. Fibrinolysis and coagulation abnormalities in systemic lupus erythematosus. Relationship with Raynaud's phenomenon, disease activity, inflammatory indices, anticardiolipin antibodies and corticosteroid therapy. Rheumatol. Int., 1995, 14(5), 207-211</p><p>Tan E.M., Cohen A.S., Fries J.F. The 1982 revised criteria forthe classification of systemic lupus erythematosus. Arthr. Rheum., 1982,25, 1271-1277</p><p>Wilson W.A., Gharavi A.E., Koike T. et al. Intematonal consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthr. Rheum., 1999, 42, 1309-1311</p><p>Vitali C., Bcncivelli W., Isenberg D.A. et al. Disease activity in systemic lupus erythematosus: report of the consensus study group of the European workshop for rheumatology research. II Identification of the variables indicative of disease activity and their use in the development of an activity score. Clin. Exp Rheum,, 1992, 10,541-547</p><p>Bombardier C., Gladman D.D., Urowitz M.B. et al. The development and validation of the SLE disease activity index (SLE DAI). Arthr. Rheum., 1992, 35, 630-640.</p><p>Liang M.H., Socher S.A., Larson M.G., Schur P.H. Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthr. Rheum., 1989, 32(9), 1107-1118</p><p>Баркаган 3.C., Момот А.П. Основы нарушений диагностики гемостаза. М., "Ньюдиамед АО", 1999, 220</p><p>Ройтман Е.В., Смоляницкий А.Я. Методы исследования системы гемостаза. В кн.: Под ред. Меньшикова В.В. Клиническая лабораторная техника. Том III. Частные аналитические технологии в клинической лаборатории. М., "Лабпрссс", 2000,156-313</p><p>Drenkard С., Villa A.R., Reyes Е. et al. V&amp;sculitis in systemic lupus erythematosus. Lupus, 1997,6, 235-242</p><p>Wallberg-Jonsson S., Cvetkovic J.T., Sundqvist K.G. et al. Activation of the immune system and inflammatory activity in relation to markers of atherothrombotic disease and atherosclerosis in rheumatoid arthritis. J. Rheumatol., 2002, 29(5), 875-882</p><p>Бокарев И.Н. Дифференциальная диагностика и лечение внутренних болезней: Кровоточивость, или геморрагический синдром. Дифференциальная диагностика и лечение. М., 2002, 76</p></div><br /><div><p>Насонов Е.Л. Роль нарушений иммунитета и воспаления при ревматических заболеваниях. В кн.: В.А.Насоновой, Н.В.Бунчука, ред. Ревматические болезни. М., Медицина, 1997, 29-52</p><p>Dixit К., Ali R. Role of nitric oxide modified DNA in the etiopa.thogenesis of systemic lupus erythematosus. Lupus, 2004, 13(2), 95-100</p><p>Насонова B.A., Фоломеева O.M. Медико-социальное значение XIII класса болезней для населения России. Науч,- практ. ревматол., 2001, 1,7-11</p><p>Manger К., Manger В., Repp R. ct al. Definition of risk factors for death, end stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus. Ann. Rheum. Dis., 2002, 61(12), 1065-1070</p><p>Cervera R., Khamashta M.A., Font J. el al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore), 2003, 82(5), 299-308</p><p>Becker B.F., Heindl B., Kupatt C., Zahler S. Endothelial function and hemostasis. Z.Kardiol., 2000, 89(3), 160-167</p><p>Ekdahl K.N., Ronnblom L., Sturfelt G., Nilsson B. Increased phosphate content in complement component C3, fibrinogen, vitronectin, and other plasma proteins in systemic lupus erythematosus: covariation with platelet activation and possible association with thrombosis. Arthr. Rheum., 1997,40(12), 2178-2186</p><p>Rajagopalan S., Somers E.C., Brook R.D. et al. Endothelial cell apoptosis in systemic lupus erythematosus: a common pathway for abnormal vascular function and thrombosis propensity. Blood, 2004,-103(10), 3677-3683</p><p>Esmon C.T., Fukudome K., Mather T. et al. Inflammation, sepsis, and coagulation. Haematolog., 1999, 84(3), 254-259</p><p>Ekdahl K.N., Bengtsson A.A., Andersson J. et al. Thrombotic disease in systemic lupus erythematosus is associated with a maintained systemic platelet activation. Br. J. Haematol., 2004, 125(1), 74-78</p><p>Esmon C.T. Does inflammation contribute to thrombotic events? Haemostas., 2000, 30 (suppl. 2), 34-40</p><p>lnoh М., Tokuda М., Kiuchi H. et al. Evaluating systemic lupus erythematosus disease activity using molecular markers of hemostasis. Arthr. Rheum., 1996, 39(2), 287-291</p><p>Segal j., KicklerT., Petri M. Tissue factor activity in patients with systemic lupus erythematosus: association with disease activity. J. Rheumatol., 2000, 27(12), 2827-2832</p><p>Kiraz S., Ertcnli I., Benekli M. et al. Clinical significance of hemostatic markers and thrombomodulin in systemic lupus erythematosus: evidence for a prothrombotic state. Lupus, 1999, 8(9), 737-741</p><p>Amengual O., Atsumi Т., Khamashta M.A., Hughes G.R. The role of the tissue factor pathway in the hypercoagulable state in patients with the antiphospholipid syndrome. Thromb.Haemost., 1998, 79(2), 276-281</p><p>Gezer S. Antiphospholipid syndrome. Dis.Mon. 2003, 49(12), 696-741</p><p>Ames P.R., Alves J., Pap A.F., et al. Fibrinogen in systemic lupus erythematosus: more than an acute phase reactant? J. Rheumatol., 2000, 27(5), 1190-1195</p><p>Doria A., Ghirardello A., Boscaro M. et al. Fibrinolysis and coagulation abnormalities in systemic lupus erythematosus. Relationship with Raynaud's phenomenon, disease activity, inflammatory indices, anticardiolipin antibodies and corticosteroid therapy. Rheumatol. Int., 1995, 14(5), 207-211</p><p>Tan E.M., Cohen A.S., Fries J.F. The 1982 revised criteria forthe classification of systemic lupus erythematosus. Arthr. Rheum., 1982,25, 1271-1277</p><p>Wilson W.A., Gharavi A.E., Koike T. et al. Intematonal consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthr. Rheum., 1999, 42, 1309-1311</p><p>Vitali C., Bcncivelli W., Isenberg D.A. et al. Disease activity in systemic lupus erythematosus: report of the consensus study group of the European workshop for rheumatology research. II Identification of the variables indicative of disease activity and their use in the development of an activity score. Clin. Exp Rheum,, 1992, 10,541-547</p><p>Bombardier C., Gladman D.D., Urowitz M.B. et al. The development and validation of the SLE disease activity index (SLE DAI). Arthr. Rheum., 1992, 35, 630-640.</p><p>Liang M.H., Socher S.A., Larson M.G., Schur P.H. Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthr. Rheum., 1989, 32(9), 1107-1118</p><p>Баркаган 3.C., Момот А.П. Основы нарушений диагностики гемостаза. М., "Ньюдиамед АО", 1999, 220</p><p>Ройтман Е.В., Смоляницкий А.Я. Методы исследования системы гемостаза. В кн.: Под ред. Меньшикова В.В. Клиническая лабораторная техника. Том III. Частные аналитические технологии в клинической лаборатории. М., "Лабпрссс", 2000,156-313</p><p>Drenkard С., Villa A.R., Reyes Е. et al. V&amp;sculitis in systemic lupus erythematosus. Lupus, 1997,6, 235-242</p><p>Wallberg-Jonsson S., Cvetkovic J.T., Sundqvist K.G. et al. Activation of the immune system and inflammatory activity in relation to markers of atherothrombotic disease and atherosclerosis in rheumatoid arthritis. J. Rheumatol., 2002, 29(5), 875-882</p><p>Бокарев И.Н. Дифференциальная диагностика и лечение внутренних болезней: Кровоточивость, или геморрагический синдром. Дифференциальная диагностика и лечение. М., 2002, 76</p></div><br />

The authors declare that there are no conflicts of interest present.