血小板参数与2型糖尿病患者微量白蛋白尿及外周血管病变的关系

Relationship between platelet parameters and albuminuria and peripheral vascular complications of type 2 diabetes patients

目的:探讨血小板参数与2型糖尿病微血管和外周血管病变的关系。方法:收集650例2型糖尿病患者,检测血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、生化资料、尿微量白蛋白(MAU)以及踝肱比值(ABI)等指标。按MAU值分为MAU组和正常组,按ABI值分为外周血管病变组(PAD组)和非PAD组,分别进行两组间血小板参数和临床资料的比较,并进行影响因素分析。结果:MAU组收缩压(SBP)、总胆固醇(TC)、甘油三酯(TG)、MPV和PDW明显高于正常组(P<0.05),而高密度脂蛋白胆固醇(HDL-C)显著低于正常组(P<0.05)。PAD组腰臀比(WHR)、SBP和TC较正常组升高,HDL-C水平显著降低(P<0.05),而血小板相关参数均未见统计学差异。Logistic多元回归分析结果显示SBP、TC、TG和PDW为影响微量白蛋白尿发生的危险因素(回归系数B>0,P<0.05)。SBP、WHR及HDL-C为影响外周血管病变的独立影响因素(P<0.05)。结论:动态监测血小板参数的变化,尤其是MPV和PDW,有助于早期预测糖尿病患者微血管病变的发生。

Objective：To explore the relationship between platelet parameters and microangiopathy and peripheral arterial disease （PAD） in type 2 diabetes. Methods：Total 650 patients with type 2 diabetes were collected. The levels of platelet count （PLT）,mean platelet volume （ MPV ）, platelet distribution width （PDW）, clinical and biochemical characteristics, microalbuminuria （MAU） and ankle braehial index （ABI） were measured. The patients were divided into MAU group and normal abuminuria group according to presence or absence of MAU. The patients were also divided into PAD group and non-PAD group according to the ABI value. The comparison of platelet parameters and biochemical indices between groups was performed. The correlation of the risk factors for MAU and PAD were analyzed. Results：The level of SBP,TC,TG,MPV and PDW in MAU group were significantly higher than those in normal abuminuria group, and the level of HDL in MAU group were lower than that in normal abuminuria group （P 〈 0.05）. The differences in WHR,SBP and TC between PAD and non-PAD group were statistically significant （P 〈 0.05）. However,there was no significant difference in platelet parameters between two groups （P 〉 0.05）. Logistic multiple regression analysis shown that SBP,TC,TG and PDW were the independent risk factors of the progress of MAU. SBP,WHR and HDL were significant factors for PAD （P 〉 0.05）. Conclusion： Monitoring the platelet parameters, especially MPV and PDW, has very important prognostic value in the early diagnosis of microangiopathy in type 2 diabetes.