不同严重程度冠心病合并2型糖尿病患者血栓弹力图特点分析

Characteristics of thromboelastelastin in patients with coronary heart disease and type 2 diabetes mellitus with different severity

目的探究不同严重程度冠状动脉粥样硬化性心脏病(冠心病)合并2型糖尿病患者血栓弹力图(TEG)的特点。方法本次研究入组陕西省榆林市定边县人民医院于2015年1月~2017年1月收治的冠心病合并2型糖尿病患者90例(观察组),单纯冠心病患者90例(对照组),健康志愿者90例(空白组)。观察组根据冠状动脉CT下冠状动脉病变的数量分为1支病变组(40例)、2支病变组(29例)和3支病变组(21例)3个亚组。观察各组基线资料(性别、年龄、合并疾病和服用药物情况)、外周血炎症因子[甲壳质酶蛋白40(YKL-40)和核因子-κB(NK-κB)水平]和TEG参数[血凝块形成时间(K值),凝血反应时间(R值),血栓最大振幅(MA)和血凝块形成速率(α角)]。采用Pearson法评估炎症相关因子与TEG各参数的相关性。结果基线资料方面,3组性别比和年龄差异均无统计学意义(P均>0.05),观察组和对照组在合并疾病和用药情况方面均无统计学意义(P均>0.05)。炎症指标方面,观察组外周血YKL-40和NK-κB水平均高于对照组,对照组YKL-40和NK-κB水平均高于空白组,差异均有统计学意义(P均<0.05);观察组中,3支病变组外周血YKL-40和NK-κB水平均高于2支病变组,2支病变组YKL-40和NK-κB水平均高于1支病变组,差异均有统计学意义(P均<0.05)。TEG指标方面,MA值和α角水平观察组均高于对照组,对照组高于空白组;K值和R值水平空白组均高于对照组,对照组高于观察组(P均<0.05);观察组中,MA值和α角水平3支病变组均高于2支病变组,2支病变组高于1支病变组,K值和R值水平1支病变组均高于2支病变组,2支病变组高于3支病变组(P均<0.05)。Pearson相关性检验显示,YKL-40、NK-κB含量与MA值和α角与呈正相关,与K值和R值呈负相关(P均<0.05)。结论冠心病合并2型糖尿病患者TEG参数显著异常,且各参数与病情及炎症反应程度具有一定相关性。

Objective To explore the characteristics of Thrombelastogram(TEG)in patients with different severity of coronary heart disease and type 2 diabetes mellitus.Methods In this study,90 cases of coronary heart disease combined with type 2 diabetes admitted to the people's Hospital of Dingbian County of Yulin from January 2015 to January 2017 were selected as observation group,90 cases of only coronary heart disease were selected as control group,90 healthy volunteers were selected as blank group.According to the number of coronary artery lesions,the observation group was divided into 1-lesion group,2-lesions group and 3-lesions group,each group had 10 cases.Baseline data(sex,age,combined disease and drug use),peripheral blood inflammatory factors[chitin protein 40(YKL-40)and nuclear factor kappa B(NK-kappa B)]and TEG parameters[kinetics of clot development(K),reaction time(R),maximum amplitude(MA)and kinetics of clot development(α)]were observed.Correlation between inflammation related factors and parameters of TEG was evaluated by Pearson analysis.Results In the baseline data,there was no significant difference in sex ratio and age difference among three groups(P>0.05).There was no significant difference between the observation group and the control group in the combination of disease and drug use(P>0.05).The levels of YKL-40 and NK-kappa B in peripheral blood of the observation group was higher than those of the control group.The levels of YKL-40 and NK-kappa B in the control group was higher than those in the blank group(P<0.05).In the observation group,the levels of YKL-40 and NK-kappa B in the peripheral blood of 3-lesions group were higher than those of 2-lesions group,which were higher than those of 1-lesion group(P<0.05).The MA value and alpha angle level of the observation group were higher than those of the control group.The MA value and the alpha angle level of the control group were higher than those of the blank group.The K and R values of the blank group were higher than those of the control group.The K and R values of the control group were higher than those of the control group(P<0.05).In the observation group,the MA value and alpha angle of the 3-lesions group were in the observation group.The level of MA and alpha angle in the 2-lesions group were higher than those of the 1-lesion group.The K and R values of the 1-lesion group were higher than those of the 2-lesions group.The K and R levels in the 2-lesions group were higher than those of the 3-lesions group(P<0.05).Pearson correlation test showed that YKL-40 and NK-kappa B contents were positively correlated with MA value andα,and negatively correlated with K value and R value(P<0.05).Conclusions The TEG parameters in patients with coronary heart disease complicated with type 2 diabetes were significantly abnormal,and the parameters were correlated with the severity of the disease and the degree of inflammatory reaction.