非肥胖型2型糖尿病合并血管病变患者相关因素分析

Analysis of related factors for pathological changes of blood vessels in non-obesity type 2 diabetic patients

目的探讨非肥胖型2型糖尿病合并血管病变患者纤溶系统的特点及相关危险因素。方法选择有血管病变的非肥胖型2型糖尿病患者134例为实验组,健康人80例作为对照组。检测凝血酶激活的纤溶抑制物(TAFI)、纤溶酶原激活剂抑制物-1(PAI-1)、血管性假性血友病因子(vWF)水平及血浆纤维蛋白原(FIB)含量,测定空腹血糖、糖化血红蛋白、空腹胰岛素水平、脂代谢指标及体重指数等参数。结果与对照组比较,实验组TAFI(P<0.01)、PAI-1(P<0.05)、vWF(P<0.001)、FIB(P<0.05)水平升高。经多因素Logistic回归分析,TAFI、PAI-1、vWF、糖化血红蛋白和三酰甘油与非肥胖型2型糖尿病患者血管病变程度呈正相关(P<0.05),体重指数呈负相关(P<0.05)。结论非肥胖型2型糖尿病患者凝血活性增强并存在低纤溶状态;TAFI、PAI-1、vWF糖化血红蛋白和三酰甘油是发生血管病变的独立危险因素;体重指数<25是保护因素。

Objective To study the characteristics and related risk factors in the fibrinolytic system of non-obesity type 2 diabetic patients with pathological changes of blood vessels. Methods The case group included 134 non-obesity type 2 diabetic patients with vascular lesion; 80 healthy individuals were regarded as normal control group. The plasma level of thrombin-activatable fibri- nolysis inhibitor （TAFI）, plasminogen activator inhibitor-1 （PAI-1）, yon Willebrand factor （vWF） and fibrinogen （FIB） were measured. The level of fasting blood glucose, glycosylated hemoglobin, fasting insulin, body mass index and lipid metabolism indicators were detected as well. Results Compared with normal control group, the plasma level of TAFI （P 〈0.01）, PAI-1 （P 〈0.05） in case group were obviously increased, and the plasma level of vWF （P 〈0.001）, FIB （P 〈0.05） were also increased. The nmltifactorial logistic regression analysis showed that TAFI, PAL1, vWF, glycosylated hemoglobin and triacylglycerol had positive correlation with vascular pathologies in non-obesity type 2 diabetic patients （P 〈0.05）. Body mass index had negative correlation （P 〈0.05）. Conclusion The activity of coagulation system could be enhanced in non-obesity type 2 diabetic patients, but the activity of fibrinolysis system was decreased. TAFI, PAI-1, vWF, glycosylated hemoglobin and triacylglycerol were independent risk factors of vascular pathologies. Conversely body mass index〈25 was a protective factor.