老年2型糖尿病合并下肢骨折患者血栓分子标志物的变化

Changes of thrombosis molecular markers in elderly type 2 diabetic patients with lower extremity fractures

目的探讨骨折对老年2型糖尿病患者凝血活性的影响及与发生血栓性疾病的关系。方法测定80例老年2型糖尿病合并下肢骨折患者、80例老年2型糖尿病患者、60例年龄、体质指数相匹配的健康对照者的血浆6-酮-前列腺素F1α（6-keto—PGF1α）、血小板“颗粒膜蛋白-140（GMP-140）、血栓素B2（TXB2）、纤维蛋白原（FIB）、D-二聚体（D-D）水平，组间进行比较。结果糖尿病合并骨折组的6-keto—PGF1α测定值为（49．86±6．01）ng／L，糖尿病组为（58．92±6．44）ng／L，健康对照组为（75．34±8．21）ng／L，前两组较健康对照组的6-keto—PGF1α测定值均下降，且糖尿病合并骨折组的6-keto—PGF1α值较糖尿病组下降（F=238．776，P=0．000）；糖尿病合并骨折组GMP-140、TXB2、FIB和D-D测定值分别为（21．86±2．57）μg／L、（139．46±16．80）ng／L、（5．19±0．89）g／L和（1．13±0．27）mg／L，糖尿病组的相应测定值分别为（17．92±2．50）μg／L、（126．07±7．64）ng／L、（4．52±0．80）g／L和（0．73±0．27）mg／L，健康对照组的相应测定值分别为（13．85±1．20）±g／L、（76．94±10．60）ng／L、（3．26±0．84）g／L和（0．29±0．15）mg／L，前两组的各测定值较健康对照组均升高，且糖尿病合并骨折组较糖尿病组升高（F=191．407、463．307、90．705、202．685，均P=0．000）。结论骨折可增强老年2型糖尿病患者的凝血活性，加剧其高凝状态，容易发生血栓性疾病，应早期干预治疗。

Objective To explore the effect of lower extremity fracture （LEF） on the coagulation activity and the relationship between LEF and thrombotic diseases in the elderly type 2 diabetic patients. Methods This study included three groups： 80 elderly patients with type 2 diabetes mellitus plus LEF （DM plus fracture）, 80 elderly patients with type 2 diabetes mellitus without fracture （DM） and 60 healthy （Cont.） persons with same age and body weight index. The 6-keto-PGFla, GMP-140, TXB2, FIB and D-D levels of the 3 groups were tested and compared. Results The levels of 6 keto-PGF1α were significantly lower in groups of DM plus fracture and DM [（49.86±6.01） ng/L and （58.92±6.44） ng/L] than in control group [（75.34±8.21） ng/L], and the 6-keto-PGF1α level in DM plus fracture group was even lower （F= 238. 776, P= 0. 000）. The levels of GMP-140, TXB2, FIB and DD in DM plus fracture group were （21.86 ± 2.57） μg/L, （139.46±16.80） ng/L, （5.19±0.89） g/L and （1. 13±0.27） mg/L, the corresponding four values in diabetic group and healthy control group were as follows.. [（17.92± 2.50） μg/L and （13.85 ± 1.20）μg/L for GMP-140], [（126.07±7.64） ng/L and （76.94±10.60） ng/L for TXB2], [（4.52± 0.80） g/L and （3.26±0.84） g/L for FIB] and [（0.73±0.27）mg/L and （0.29±0.15） mg/L for D-D], all measured values were significantly higher in the DM plus fracture, and DM groups than in healthy control group, and even higher in DM plus fracture group than in DM group （F= 191. 407, 463. 307, 90. 705, 202. 685, all P=0. 000）. Conclusions Fracture could enhance the coagulation activity and the high thrombotic state in type 2 diabetic patients, which may lead to thrombotic diseases, and need to be intervened early.