糖代谢异常患者凝血状态变化及二甲双胍干预作用的研究

Study on coagulation indices, clotting factors in patients with abnormal glucose metabolism and the intervention effects of metformin

目的研究糖代谢异常患者血浆同型半胱氨酸（Hcy）、凝血状态的变化及二甲双胍的干预作用,为糖代谢异常患者的有效干预提供参考。方法于2015年1月至2016年1月选取新发2型糖尿病（T2DM）患者、糖耐量受损（IGT）患者各60例及正常对照30例作为研究对象,计算体质指数（BMI）,测定血压、空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（Hb A1C）、总胆固醇（TC）、甘油三酯（TG）、Hcy、凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血因子Ⅶ、Ⅷ水平及活性等。两组患者给予二甲双胍治疗12周,再次测定以上指标,观察治疗前后各指标的变化,并与对照组比较。对照组未做处理。采用SPSS 11.5软件进行t检验、Pearson相关分析和logistic回归分析。结果 T2DM、IGT组经二甲双胍治疗后,FPG及2 h PG、Hb A1C、Hcy、PT、凝血因子Ⅶ、Ⅷ活性与治疗前相比,差异均有统计学意义（P〈0.05,P〈0.01）,T2DM组经二甲双胍治疗后APTT也明显延长,差异有统计学意义（P〈0.05,P〈0.01）。T2DM组Hcy水平与凝血因子Ⅶ、Ⅷ活性呈正相关（r值分别为0.44、0.39,P〈0.05）,与PT、APTT呈负相关（r值分别为-0.28、-0.26,P〈0.05）。凝血因子Ⅶ、Ⅷ活性升高是Hcy的危险因子[OR值分别为1.72（95%CI：1.12~2.54）、1.66（95%CI：1.11~2.47）],PT、APTT升高是Hcy的保护因子[OR值分别为0.68（95%CI：0.46~0.94）、0.66（95%CI：0.43~0.98）]。结论 T2DM、IGT患者存在不同程度糖代谢紊乱和凝血功能异常,二甲双胍可改善糖代谢并影响凝血功能。

Objective To study the homocysteine（Hcy）, coagulation indices, clotting factors in patients with abnormal glucose metabolism and the intervention effects of metformin. Methods The subjects of this study were 60 patients with T2 DM, 60 patients with IGT and 30 normal healthy controls. Two groups of patients were treated with metformin for 12 weeks, the changes of BMI, BP, FPG, 2 h PG, Hb A1 C, TC, TG, Hcy, prothrombin time（PT）, activated partial prothrombin time（APTT）, clotting factorⅦ（Ⅶ）, clotting factor Ⅷ（Ⅷ）before and after the treatment with metformin were observed for all subjects. The t test, Pearson correlation analysis and Logistic regression analysis were used to analyze the data with SPSS 11.5 software. Results There were the significant differences of FPG, 2 h PG, Hb A1 C, Hcy, PT, clotting factor Ⅶ（Ⅶ）, clotting factor Ⅷ（Ⅷ）after treatment with metformin in two patient groups（P〈0. 05 or P〈0. 01）. Also APTT after treatment with metformin in T2 DM group prolonged significantly（P〈0.05）. There was a positive correlation between Hcy level and the activities of clotting factor Ⅶ or Ⅷ（r values were 0.44, 0.39, respectively, P〈0.05）and a negative correlation between Hcy level and PT or APTT（r values were-0.28,-0.26 respectively, P〈0.05）. Logistic analysis showed that the enhanced activities of clotting factor Ⅶ or Ⅷ were risk factors for Hcy（OR=1.72, 95%CI： 1.12-2.54 and OR=1.66, 95%CI： 1.11-2.47）, and the prolonged PT or APTT were protective factors for Hcy（OR=0.68, 95%CI： 0.46-0.94 and OR=0.66, 95%CI： 0.43-0.98）. Conclusion There are the different degrees of abnormal glucose metabolism and coagulation dysfunction in T2 DM and IGT patients, the metformin can improve the glucose metabolism and influence the function of blood coagulation.