2型糖尿病患者凝血状态研究

The study of blood coagulation status in type 2 diabetes mellitus

目的探讨2型糖尿病患者合并血管病变对凝血状态的影响。方法纳入2型糖尿病住院患者311例,依据有无大血管并发症分为3组,即单纯糖尿病组130例,糖尿病合并高血压组151例,糖尿病合并冠心病组30例,同时选择我院同期健康体检者30例作为健康对照组。检测抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、蛋白S(PS)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、血浆纤维蛋白原(Fib)、血浆凝血酶时间(TT))水平评价凝血功能。结果与健康对照组相比较,糖尿病组AT-Ⅲ、PC、PS活性明显降低,凝血四项中APTT、PT降低、Fib升高,2组比较差异有统计学意义(P<0.05)。糖尿病合并冠心病组与单纯糖尿病组相比,PC、PS差异有统计学意义(P<0.05)。糖尿病合并冠心病组Fib及PLT升高较单纯糖尿病组更为明显,差异有统计学意义(P<0.05)。结论糖尿病患者抗凝血功能紊乱,处于血栓前状态,合并心血管并发症患者尤为明显。AT-Ⅲ、PC、PS及凝血四项的测定可能有利于糖尿病患者凝血状态的评估,有利于血管并发症的早期干预。

Objective To explore the changes and clinical significance in coagulation anti-coagulation and fibrinolysis system in patients with type 2 diabetes mellitus（DM）.Methods To measure thrombin time（TT）,activated partial thromboplastin time（APTT）,prothrombin time（PT）,and fibrinogen（Fib）,anti-thrombinⅢ（AT-Ⅲ）,protein C（PC）,protein S （PS）in 311 patients with type 2 diabetes mellitus from 2010 to 2011.These patients were categorized as single DM group, DM with hypertension group,DM with coronary heart disease group.At the same time,30 healthy people were selected as contrast group.SPSS software was used for statistic analysis.Results The activity of AT-Ⅲ,PC,PS of type 2 diabetes mellitus were progressively lower than those of control group.There was a significant difference between single DM group and DM with coronary heart disease group.The level of APTT,PT had shortened compared with normal controls.The level of plasma Fib of type 2 diabetes had raised significantly than that of normal controls.Conclusion Coagulation function was disordered in patients with type 2 diabetes mellitus;especially those with vascular complications.AT-Ⅲ,PC,PS,APTT,PT,Fib were helpful for evaluating coagulation function.It would be important for the diagnosis and therapy of hyper-coagulable state in DM patients.