D-ДИМЕР ПРИ СЕРПОВИДНОКЛЕТОЧНОЙ АНЕМИИ: ОБЗОР ДАННЫХ О ЕГО СТОЙКОМ ПОВЫШЕНИИ И ВЛИЯНИИ НА СЕРДЕЧНО-СОСУДИСТУЮ СИСТЕМУ

Основные положения

• У пациентов с серповидноклеточной анемией (СКА) высок риск тромботических осложнений из‑за хронического гемолиза, воспаления и гиперкоагуляции.
• D‑димер– перспективный маркер риска и эффективности терапии при СКА, но его применение осложнено стойким повышением базового уровня и отсутствием стандартизированных пороговых значений.
• Для внедрения D‑димера в клиническую практику необходимы проспективные исследования и разработка специализированных протоколов.

Резюме

Хронический гемолиз, воспаление и протромботический статус, который является фактором риска явных и субклинических тромботических осложнений, наблюдаются у пациентов с серповидноклеточной анемией (СКА) с рождения.  D-димер, один из наиболее часто используемых продуктов распада фибрина для оценки риска венозной тромбоэмболии, стал показателем риска и степени тяжести тромбоэмболии при СКА.  Однако его клиническое применение затруднено из-за постоянного повышения исходного уровня D-димера, вызванного хроническим воспалением и гиперкоагуляцией.  В этом обзоре рассматривается диагностическая и прогностическая роль D-димера при СКА, а также возможность его использования для скрининга, стратификации риска и мониторинга во время лечения.  Другие диагностические стратегии, в том числе применение инструментов клинической оценки риска, таких как шкала Уэллса, рассматриваются с точки зрения их адекватности и применимости в данной группе пациентов.  Также обсуждается влияние антикоагулянтной терапии на динамику уровня D-димера, что указывает на возможность использования D-димера в качестве показателя эффективности такого лечения.  Однако, несмотря на перспективность этого метода, его рутинное применение затруднено из-за отсутствия стандартизированных пороговых значений и мешающих интерпретации факторов. Необходимая разработка проспективных исследований и мультимаркерных групп, а также верификация протоколов, связанных с SCA, имеют решающее значение для внедрения D-димера в практику лечения SCA. Важно отметить тот факт, что стойкое повышение уровня D-димера может не только не увеличить риск тромбоза, но и может быть использовано в качестве маркера сердечно-сосудистого риска и в качестве подхода к лечению хронических заболеваний. Необходимы дальнейшие исследования для включения D-димера в комплексную систему точной медицины SCA.

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