血栓弹力图在2型糖尿病合并冠心病患者中的应用

Application of thrombelastogram in patients with type 2 diabetic mellitus and coronary heart disease

目的探索血栓弹力图在2型糖尿病合并冠心病患者中的临床应用效果。方法 197例冠心病患者,按照是否合并2型糖尿病分为糖尿病组(64例)和非糖尿病组(133例)。入院后行常规检查及血栓弹力图检测,分析血栓弹力图各指标在两组间的差异。结果糖尿病组患者血栓弹力图主要参数反应时间(R)、凝固时间(K)、血凝块溶解百分比(EPL)、30 min血凝块幅度减少速率(Ly30)低于非糖尿病组,凝固角(Angle角)、血小板最大聚集率(MA)高于非糖尿病组,差异有统计学意义(P<0.05)。糖尿病组患者低密度脂蛋白、超敏C反应蛋白(CRP)、空腹血糖、糖化血红蛋白、血小板计数、纤维蛋白原低于非糖尿病组,差异有统计学意义(P<0.05)。糖尿病组二磷酸腺苷(ADP)抑制率为(57.10±27.25)%血小板纤维蛋白凝块强度(MAADP)为(29.78±15.97)mm低于非糖尿病组的(64.53±29.24)%、(34.52±14.71)mm,差异有统计学意义(P<0.05)。两组花生四烯酸(AA)抑制率比较差异无统计学意义(P>0.05)。结论冠心病合并2型糖尿病患者存在血液高凝状态,有血栓栓塞风险。冠心病合并2型糖尿病患者ADP抑制率低,预防心血管事件需加强抗血小板治疗。

Objective To explore the clinical application effect of thrombelastogram in patients with type2diabetic mellitus and coronary heart disease.Methods A total of197coronary heart disease patients were divided by combining with type2diabetic mellitus or not into diabetic group(64cases)and non-diabetic group(133cases).Patients received conventional examination and thrombelastogram detection after admission,and analysis was made on differences of all thrombelastogram indexes in two groups.Results The diabetic group had lower thromboelastogram main parameters of the reaction time(R),coagulation time(K),estimate percent lysis(EPL),reducing rate of lysis in30min(Ly30)than non-diabetic group,and higher solidification angle(Angle angle)and maximum agglutination(MA)than non-diabetic group.Their difference had statistical significance(P<0.05).The diabetic group had lower low density lipoprotein cholesterol,high sensitive C-reaction protein(CRP),fasting glucose,glycosylated hemoglobin,platelet count,fibrinogen than non-diabetic group,and the difference had statistical significance(P<0.05).The diabetic group had adenosine diphosphate(ADP)inhibition ratio as(57.10±27.25)%,MA induced by ADP(MAADP)as(29.78±15.97)mm,which were all lower than(64.53±29.24)%and(34.52±14.71)mm in nondiabetic group,and their difference had statistical significance(P<0.05).Both groups had no statistically significant difference in arachidonic acid(AA)inhibition ratio(P>0.05).Conclusion Patients with coronary heart disease and type2diabetic mellitus have high blood coagulation state and thromboembolism risk,and they have low ADP inhibition ratio.Antiplatelet therapy should be strengthened to prevent cardiovascular events.