早期糖尿病肾病患者血栓风险分析

Risk analysis of thrombosis in early diabetic nephropathy patients

目的分析早期糖尿病肾病患者血栓风险及影响因素。方法选取2017年5月～2018年5月在河北省沧州中西医结合医院(以下简称"我院")内分泌科就诊的2型糖尿病患者120例,其中尿白蛋白定量/尿肌酐(ACR)正常[ACR<2.5(男)/3.5(女)mg/mmol]的60例作为2型糖尿病组(T2DM组),ACR在2.5(男)/3.5(女)～30.0 mg/mmol之间的60例作为早期糖尿病肾病组(EDN组)。另选取我院健康体检者30名作为对照组(NC组)。检测各组代谢指标,包括空腹血糖(FPG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA_(1c))、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG),以及血栓弹力图(TEG)的R值、K值、CI值、MA值、Angle角值,评估血栓形成的危险因素。结果与NC组比较,T2DM组及EDN组FPG、2hPBG、HbA1c水平均升高(P <0.05);与T2DM组比较,EDN组FPG、2hPBG、HbA1c水平均升高(P <0.05)。与NC组比较,T2DM组及EDN组TG、TC、LDL-C水平均升高(P <0.05),但T2DM组与EDN组TG、TC、LDL-C水平比较差异无统计学意义(P> 0.05)。与NC组比较,T2DM组及EDN组的R值、K值均降低,Angle角值、MA值、CI值均升高,差异有统计学意义(P <0.05);与T2DM组比较,EDN组R值、K值下降,Angle角值、MA值、CI值上升,差异有统计学意义(P <0.05)。直线相关分析显示R值、K值与ACR呈负相关(r=-0.423、-0.517,均P <0.01),Angle角值、MA值、CI值与ACR呈正相关(r=0.683、0.742、0.669,均P <0.01)。Logistic回归分析显示:糖尿病病程、血脂异常、吸烟史、ACR升高为早期糖尿病肾病患者血栓风险的独立危险因素(OR=2.423、1.986、2.103、4.358,均P <0.05)。结论糖尿病患者在未出现蛋白尿前,血栓风险已经高于健康成人。早期糖尿病肾病患者血栓风险高于单纯糖尿病患者。早期糖尿病肾病患者的血栓风险与糖尿病病程、血脂异常、吸烟史、ACR升高相关。

Objective To study the risk and influencing factors of thrombosis in patients with early diabetic nephropathy. Methods One hundred and twenty patients with type 2 diabetes that admitted to Endocrinology Department of Cangzhou Hospital of Integrated Chinese and Western Medicine（＂our hospital＂ for short） from May 2017 to May 2018 were selected, with 60 cases ACR〈2.5 （male）/3.5 （female） mg/mmol as type 2 diabetes group （T2DM group）, 60 cases ACR from 2.5 （male）/3.5 （female） mg/mmol to 30.0 mg/mmol as early diabetic nephropathy group （EDN group）. And 30 cases of health check-up in our hospital were taken as the control group（NC group）. The metabolism indexes of each group were detected as fasting blood-glucose （FPG）, postprandial 2 h plasma glucose （2hPBG）, glycosylated hemoglobin （HbA1c）, total cholestero （TC）, low-density lipoprotein cholesterol （LDL-C）, triacylglycerol （TG）, and thrombelastogram （TEG） indexes as R value, K value, CI value, MA value, Angle angle value to assess the risk of thrombosis. Results Compared with the NC group, the levels of FPG, 2hPBG, HbA1c of T2DM group and EDN group increased （P ＜ 0.05）; compared with the T2DM group, the levels of FPG, 2hPBG, HbA1c of EDN group increased （P ＜ 0.05）. Compared with the NC group, the levels of TG, TC, LDL-C of T2DM group and EDN group increased （P ＜ 0.05）, while there was no significant difference in the levels of TG, TC, LDL-C between T2DM group and EDN group （P ＞ 0.05）. Compared with the NC group, the R value and K value of T2DM group and EDN group decreased, while the Angle value, MA value and CI value increased, and the differences were statistically significant （P 〈 0.05）; compared with the T2DM group, the R value and K value of the EDN group decreased, while the Angle value, MA value and CI value increased, the differences were statistically significant （P 〈 0.05）. Linear correlation analysis showed that ACR was negatively correlated with R value and K value （r = -0.423, -0.517, all P 〈 0.01）, ACR was positively correlated with Angle value, MA value and CI value （r = 0.683, 0.742, 0.669, all P 〈 0.01）. Logistic regression analysis showed that the course of diabetes, dyslipidemia, smoking history, and ACR increase were independent risk factors for thrombosis in patients with early diabetic nephropathy （OR = 2.423, 1.986, 2.103, 4.358, all P 〈 0.05）. Conclusion Diabetics have a higher risk of blood clots than healthy adults before proteinuria. Patients with early diabetic nephropathy have a higher risk of thrombosis than those with simple diabetes. The risk of thrombosis in patients with diabetic nephropathy is related to the course of diabetes, smoking history, dyslipidemia, and elevated ACR.