高血糖对于慢性阻塞性肺疾病患者凝血功能影响

Effect of hyperglycemia on coagulation function in patients with chronic obstructive pulmonary disease

目的 探讨高血糖对于慢性阻塞性肺疾病急性加重期（AECOPD）患者肺功能与凝血功能影响及机制分析。方法 选择2014-12～2016-12诊断AECOPD患者150例，依据患者入院24 h内空腹血糖水平分为血糖正常组患者80例，血糖升高组患者70例。比较两组患者第1秒用力呼气量（FEV1）、第1秒用力呼气量占用力肺活量的百分比（FEV1/FVC）、FEV1占预计值的百分比（FEV1%pred）与6 min步行距离。入院后24 h内晨空腹抽取肘静脉，采用ELISA法检测血清中白细胞介素-6（IL-6, ng/L）、单核细胞趋化蛋白-1（MCP-1, pg/mL）、中性粒细胞明胶酶蛋白（NGAL, μg/L）、免疫比浊法检测血清C反应蛋白（CRP, mg/L）水平。酶联荧光分析法检测血浆D-二聚体（D-D, ng/mL）、纤维蛋白原（Fib, g/L）。结果 血糖升高组与血糖正常组比较，患者FEV1［（1.27±0.36）L vs.（1.55±0.28）L,t=2.962］、FEV1/FVC［（43.90±10.58）% vs.（58.51±11.62）%,t=2.781］,FEV1%pred［（34.87±11.96）% vs.（48.18±12.54）%,t=2.805］，6 min步行距离［（354.78±54.51）m vs.（412.59±61.69）m,t=2.903］水平明显下降，两组比较差异有统计学意义（P＜0.05）；血清IL-6［（22.70±3.52）ng/L vs.（11.85±4.01）ng/L,t=2.905］、MCP-1［（9.83±0.76）pg/mL vs.（6.15±0.81）pg/mL,t=2.991］、NGAL［（3.91±0.37）μg/L vs.（1.03±0.25）μg/L,t=2.740］,血浆D-D［（2.76±0.51）ng/mL vs.（1.18±0.45）ng/mL,t=2.903］、Fib［（4.78±0.25）g/L vs.（3.01±0.37）g/L,t=2.691］明显升高，两组比较差异有统计学意义（P＜0.05）。结论 高血糖可以增加AECOPD患者凝血机制与纤溶功能紊乱，加重肺功能损伤程度，分析原因与高血糖刺激血清炎症介质水平升高有关。

Objective To investigate the effect and its mechanism of hyperglycemia on the pulmonary function and blood coagulation in patients with acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods From December 2014 to December 2016, 150 patients with acute exacerbation of chronic obstructive pulmonary disease were enrolled. According to the fasting blood glucose level within 24 hours after admission, 80 patients were divided into normal blood glucose group and 70 patients with elevated blood glucose. The percentage of forced expiratory volume in the first second （FEV1）, the forced expiratory volume in the first second （FEV1/FVC）, the percentage of FEV1 in the predicted value and the walking distances of 6 mins were compared between the two groups. ELISA method was used to detect serum interleukin -6 （IL -6,ng/L）, monocyte chemoattractant protein - 1 （MCP - 1, pg/mL） , neutrophil gelatinase protein （NGAL,μg/L） , and serum turbidimetric assay were used to detect serum C - reactive protein （ CRP, mg/L）. The levels of plasma D - dimer （D -D, ng/mL） and fibrinogen （FIB, g/L） were measured by enzyme -linked immunosorbent assay. Results Compared with normal blood glucose group, the percentage of FEV1 [ （ 1.27 ± 0.36） vs. （1.55±0.28） L, t =2.962], FEV1/FVC [（43.90±10.58）% vs. （58.51 ±11.62）%, t = 2. 781 ], the percentage of FEV1 in the predicted value [ （3d. 87 ± 11.96） % vs. （48.18 ± 12.54） %, t = 2. 805 ], 6 - min walking distance [ （354.78 ± 54.51 ） m vs. （412.59 ± 61.69） m, t = 2. 903 ], the difference between the two groups was statistically significant （P 〈 0.05）. Serum IL - 6 [ （22.70 ± 3.52） ng/Lvs. （11.85±4.01） ng/L, t=2.905], MCP-1 [（9.83 ±0.76） pg/mLvs. （6.15± 0.81） pg/mL, t=2.401], NGAL [（3.91 20.37） μg/L vs. （1.03 20.25） μg/L, t=2.740], plasma D - dimer [ （ 2.76 ± 0.51 ） ng/mL vs. [ （ 1.18 ± （0.45） ng/mL, t = 2. 9031 and Fib [ （4.78 ± 0.25） g/L vs. （ 3. 01 ± 0.37） g/L, t = 2. 691 ] , the difference was statistically significant （P 〈 0.05 ）. Conclusion Hyperglycemia can increase the coagulation mechanism and fibrinolytic dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease, aggravate the severity of impairment of lung injury, the cause of this study was related to the increase of serum inflammatory mediators stimulated by hyperglycemia.