糖尿病合并急性脑梗死患者糖化清蛋白水平与抗凝血酶Ⅲ活性的关系研究

Relationship between Levels of Glycated Albumin and Activity of Antithrombin Ⅲ in Diabetic Patients Combined with Aute Cerebral Infarction

背景糖尿病患者易伴发急性脑梗死,且血糖水平与急性脑梗死的发病率及严重程度有关。抗凝血酶Ⅲ是一种生理性抗凝因子,当其活性降低时,发生血栓性疾病的风险增加。糖化清蛋白反映体内2~3周的血糖水平,在糖尿病致动脉粥样硬化中发挥重要作用。但既往探讨糖化清蛋白水平与抗凝血酶Ⅲ活性、急性脑梗死关系的研究较少。目的比较不同糖化清蛋白水平的糖尿病合并急性脑梗死患者的血浆抗凝血酶Ⅲ活性。方法选取2014年5—12月首都医科大学附属北京朝阳医院住院治疗的糖尿病合并急性脑梗死患者239例为研究对象,根据糖化清蛋白水平分为A组(糖化清蛋白<17.0%,88例)和B组(糖化清蛋白≥17.0%,151例)。入院即刻检测血浆抗凝血酶Ⅲ活性,入院次日检测空腹血糖、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及糖化清蛋白水平。结果 B组空腹血糖、TG、LDL-C水平均高于A组(P<0.05)。A组血浆抗凝血酶Ⅲ活性高于B组〔(106.6±10.9)%与(103.8±9.2)%,t=2.017,P=0.045〕。糖尿病合并急性脑梗死患者血浆抗凝血酶Ⅲ活性与空腹血糖、糖化清蛋白水平呈负相关(r=-0.188、-0.165,P<0.05),与HDL-C水平呈正相关(r=0.200,P<0.05)。多元逐步线性回归分析显示,空腹血糖(b=-1.149)和HDL-C(b=7.056)是糖尿病合并急性脑梗死患者抗凝血酶Ⅲ活性的独立影响因素(P<0.05)。结论糖化清蛋白水平升高的糖尿病合并急性脑梗死患者血浆抗凝血酶Ⅲ活性降低。

Background Many diabetic patients suffer from acute cerebral infarction,and the levels of blood glucose are related to the morbidity and severity of acute cerebral infarction.Antithrombin Ⅲ is a physiological anticoagulant factor,which contributes to the increased risk of thrombotic diseases when its activity reduces.Glycated albumin,reflecting the 2 to 3weeks inside level of blood glucose,plays a key role in diabetes-related atherosclerosis.However,there have been few studies on the relationship between glycated albumin levels and antithrombin Ⅲ or cerebral infarction.Objective To compare the activity of antithrombin Ⅲ of diabetic patients combined with acute cerebral infarction under different glycated albumin levels.Methods Two hundred and thirty-nine diabetic patients combined with acute cerebral infarction who were hospitalized in Beijing Chao-yang Hospital,Capital Medical University from May to December in 2014 were chosen as research objects.According to the glycated albumin levels of subjects,they were divided into group A（ glycated albumin 17.0%,88cases）,and group B（ glycated albumin ≥ 17.0%,151 cases）.The activity of plasma antithrombin Ⅲ was measured immediately after admission,and the levels of fasting blood glucose,total cholesterol（ TC）,triglyceride（ TG）,low density lipoprotein cholesterol（ LDL-C）,high density lipoprotein cholesterol（ HDL-C） and glycated albumin were measured on the day after admission.Results The levels of fasting blood glucose,TG and LDL-C in group B were significantly higher than those in group A（ P〈0.05）.The activity of antithrombin Ⅲ in group B 〔（ 103.8 ± 9.2） % 〕was significantly lower than that in group A 〔（ 106.6 ± 10.9） %,t = 2.017,P = 0.045〕.The activity of antithrombin Ⅲ was negatively associated with levels of fasting blood glucose and glycated albumin（ r =-0.188,-0.165,P〈0.05）,and positively related to HDL-C（ r = 0.200,P〈0.05）.Multiple linear regression analysis showed that fasting plasma glucose（ b =-1.149） and HDL-C（ b = 7.056） were independent predictors of the activity of antithrombin Ⅲ in diabetic patients combined with acute cerebral infarction（ P〈0.05）.Conclusion The increased glycated albumin level of diabetic patients combined with acute cerebral infarction have a lower activity of plasma antithrombin Ⅲ.