血浆抗凝血酶在糖尿病微血管病变中的机制研究

The mechanism of plasma antithrombin in diabetic microangiopathy

目的通过观察血浆抗凝血酶(AT)活性在糖尿病性视网膜病变、糖尿病性肾病和糖尿病性神经系统病变等的变化,来探讨其与疾病机制和预后的关系。方法回顾性分析我院2017年1-5月内分泌科和肾脏科T2DM合并微血管病变的住院患者共79例,根据病情分为四组:糖尿病视合并网膜病变组17例、糖尿病合并慢性肾脏疾病(3/4期)组25例,糖尿病合并周围神经系统病变组22例,糖尿病合并心肌病变组15例;另选我院同期进行体检健康者80例作为健康对照(NC)组。结果糖尿病微血管病变组与健康对照组比较,在性别、年龄、PLT、高密度脂蛋白(HDL-C)比较差异无统计学意义(P>0.05);与空腹血糖(FBG)、餐后2h血糖(2hPG)、胆固醇(CHOL)、甘油三酯(TG)、低密度脂蛋白(LDL-C)呈负相关,差异有统计学意义(P<0.05);在AT活性中,四组患者均与健康对照组比较差异有统计学意义(P<0.05),视网膜病变组与心肌病组比较差异有统计学意义(P<0.05);在D-二聚体(D-D)与纤维蛋白原(Fg)含量中,四组患者均与健康对照组比较差异有统计学意义(P<0.05),四组间两两比较差异无统计学意义(P>0.05);在糖化血红蛋白(HbA1c)含量中,四组患者均与健康对照组比较差异有统计学意义(P<0.05),视网膜病变组与神经系统病变组比较差异有统计学意义(P<0.05),肾病组与心肌病组比较差异无统计学意义(P>0.05)。结论AT活性与糖尿病微血管病变的发生及严重程度有着密切的关系,尤其在基层医院,有助于筛查糖尿病患者潜在微血管病变的危险人群,提前进行预防干预,从而改善患者预后。

Objective Changes of plasma anticoagulase (AT) activity were observed in diabetic retinopathy, diabetic nephropathy and diabetic neuropathy, thus its relationships with disease mechanism and prognosis were discussed herein. Methods A total of 79 T2DM with microvascular lesions cases in Endocrinology Department and Nephrology Department were retrospectively analyzed from January to May 2017. Patients were divided into four groups according to the illness condition below: diabetes merged retinal lesions (17 cases), diabetes with stage 3-4 chronic kidney disease (25 cases), diabetes combined with peripheral nervous system lesions (22 cases), diabetes mellitus with cardiomyopathy (15 cases). In addition, eighty healthy subjects who underwent physical examination in our hospital during the same period were selected as the health control (NC) group. Result There were no significant difference in sex, age, PLT, and HDL (hdl-c) between diabetic microangiopathy group and healthy control group (P>0.05), and negative correlations of fasting glucose (Fg), postprandial 2hPG (2hPG), cholesterol (CHOL), triglycerides (TG) and low-density lipoprotein (ldl-c) were observed (P<0.05). As for activity of AT, significant differences between the four groups of patients and the healthy control group were detected (all P<0.05), and there was significant difference between the retinopathy group and the cardiomyopathy group (P<0.05). Similarly, the d-dimer (d-d) and fibrinogen (Fbg) varies significantly between the four groups of patients and the healthy control group (P<0.05), but no significant difference was found when comparing one to another between the case groups (P>0.05). Besides, there were significant differences in the contents of HbA1c between the four groups of patients and the healthy control group (P<0.05), and the HbA1c level of retinopathy group and the neuropathy group had obviously difference (P<0.05) but not between the nephropathy group and the cardiomyopathy group (P>0.05). Conclusion The activity of AT is closely related to the occurrence and severity of diabetic microvascular diseases, especially in primary hospitals. It is helpful to screen the potentially high-risk?population of diabetic microvascular diseases and carry out preventive intervention in advance, so as to improve the prognosis of patients.