2型糖尿病患者脊柱手术后发生下肢深静脉血栓的危险因素研究

Risk factors for lower extremity deep venous thrombosis after spinal surgery in patients with type 2 diabetes

目的探讨2型糖尿病患者脊柱手术后发生下肢深静脉血栓(LEDVT)的危险因素,为临床治疗提供一定的参考依据。方法采用回顾性的方法收集2014-05-2016-05在我科接受脊柱手术治疗后出现LEDVT的78例2型糖尿病患者(LEDVT组)及同期在我科接受脊柱手术治疗后未出现LEDVT的78例2型糖尿病患者(非LEDVT组)作为研究对象,收集两组患者的基本资料及术前各项实验室检查结果,包括年龄、性别、体重指数(BMI)、吸烟史、饮酒史、婚姻史、文化程度、红细胞数目、白细胞数目、血小板计数、高血压史、糖化血红蛋白(HbA1c)、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、脑血栓史、D-二聚体、冠心病、静脉曲张、恶性肿瘤史、手术时间、麻醉方法、术后使用低分子肝素抗凝,采用单因素及多因素非条件logistic回归分析出现LEDVT的危险因素。结果单因素logistic回归分析结果显示:年龄、BMI、吸烟、高血压史、HbA1c、高密度脂蛋白、低密度脂蛋白、脑血栓史、D-二聚体、冠心病、静脉曲张、手术时间、麻醉方法、术后使用低分子肝素抗凝与LEDVT的发生相关;多因素非条件logistic回归分析结果显示:年龄、BMI、吸烟、高血压、HbA1c、高密度脂蛋白、低密度脂蛋白、D-二聚体、静脉曲张、手术时间是LEDVT发生的危险因素,而高密度脂蛋白是LEDVT发生的保护性因素。结论年龄、BMI、吸烟、高血压、HbA1c、低密度脂蛋白、D-二聚体、静脉曲张、手术时间均是2型糖尿病患者脊柱手术后发生下肢深静脉血栓的危险因素,而高密度脂蛋白则是保护性因素,临床需给予注意。

Objective To investigate the risk factors of lower extremity deep venous thrombosis （LEDVT） in patients with type 2 diabetes mellitus （T2DM） after spinal surgery, and to provide reference for elinieal treatment. Methods From May 2014 to May 2016, 78 TzDM patients with LEDVT in our department received spinal surgery （LEDVT group） and 78 T2DM patients without LEDVT at the same period （non LEDVT group） were collected as the research subjects, The basic data and preoperative lab resuhs were collected, including age, gender, body mass index （BMI）, smoking history, drinking history, marital history, culture degree, the number of red blood cells, white blood eell count, platelet eount, history of hypertension, glycosylated hemoglobin （HhA lc）, triglyeerides, total cholesterol, high density lipoprotein, low density lip〈~protein, history of cerebral thrombosis, D-dimer, coronary heart disease, varicose veins, history of malignaney, operation time, anesthesia method, postoperative use of low molecular weight heparin. Single factor and multi factor non conditional logistic regression analysis was used to analyze the risk factors of LEDVT. Results Univariate logisti（ regression analysis showed that age, BMI, smoking,history of hypertension, HbAlc, high density lipoprotein, low density lipoprotein, history of cerebral thrombosis, D-dimer, coronary heart disease, varicose veins, operation time, anesthesia method, postoperative use of low molecular weight heparin anticoagulation were associated with LEDVT（P〈O.05）. The multi factor non conditional logistic regression analysis showed that age, BMI, smoking, hypertension, HbAlc, high density lipoprotein, low density lipoprotein, D-dimer, varicose veins, the operation time were the risk factors of LEDVT, and high density lipoprotein was protective factor of LEDVT （P〈0.05）. Conclusion Age, BMI, smoking, hypertension, HbAI c, low density lipoprotein, D-dimer, varicose veins, the operation time are risk factors of LEDVT after spinal surgery in patients with T2DM, and high density lipoprotein is a protective factor, which need clinical attention.