2型糖尿病患者HbA1c水平与脑梗死发生率、血浆PAI-1水平的关系

Relationship among incidence rate of cerebral infarction, plasma PAI-1 level and HbA1c level in patients with type 2 diabetes mellitus

目的:评估2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)水平与脑梗死发生率、血浆纤溶酶原激活物抑制剂(PAI)-1水平的关系。方法:根据糖化血红蛋白(HbA1c)水平,330例T2DM患者被分为低水平组(HbA1c≤6.5%,110例)、中水平组(HbA1c 6.6%~7.5%,110例)和高水平组(HbA1c>7.5%,110例)。随访3年,观察比较三组1年内和3年内脑梗死发生率,入组和完成研究时的血浆PAI-1水平。结果:三组1年内脑梗死发生率无显著差异,P=0.254。与低水平组比较,高水平组3年内脑梗死发生率(2.73%比12.73%)显著升高,P=0.005。三组完成研究时血浆PAI-1水平均显著高于入组时,P均=0.001;与低水平组比较,中、高水平组入组时和完成研究时的血浆PAI-1水平[入组时:(30.21±0.07)μmol/L比(30.34±0.06)μmol/L比(30.55±0.08)μmol/L,完成研究时:(40.18±0.05)μmol/L比(40.98±0.31)μmol/L比(41.55±0.13)μmol/L]显著升高,且高水平组的显著高于中水平组,P均=0.001。结论:HbA1c水平显著影响脑梗死的发生率和凝血纤溶系统,而且随着糖尿病病程的延长,其对凝血纤溶系统的影响越显著。

Objective:To assess relationship among incidence rate of cerebral infarction(CI),plasma level of plasminogen activator inhibitor(PAI)-1 and glycosylated hemoglobin A1c(HbA1c)in patients with type 2 diabetes mellitus(T2DM).Methods:According to HbA1c level,a total of 330 T2DM patients were divided into low level group(HbA1c≤6.5%,n=110),medium level group(HbA1c 6.6%~7.5%,n=110)and high level group(HbA1c>7.5%,n=110).After three-year follow-up,incidence of CI within one year and three years,plasma PAI-1 level at enrollment and end of study were observed and compared among three groups.Results:There was no significant difference in incidence rate of CI within one year among three groups,P=0.254.Compared with low level group,there was significant rise in incidence rate of CI(2.73%vs.12.73%)within three years in high level group,P=0.005.At the end of study,plasma PAI-1 levels in three groups were significantly higher than those of at enrollment,P=0.001 all;compared with low level group,there were significant rise in plasma PAI-1[at enrollment:(30.21±0.07)μmol/L vs.(30.34±0.06)μmol/L vs.(30.55±0.08)μmol/L,end of study:(40.18±0.05)μmol/L vs.(40.98±0.31)μmol/L vs.(41.55±0.13)μmol/L]in medium and high level group at enrollment and end of study,and those of high level group were significantly higher than those of medium level group,P=0.001 all.Conclusion:HbA1c level significantly affects incidence rate of cerebral infarction and coagulation fibrinolysis systems,and its influence on coagulation fibrinolysis system gets more significant along with DM course prolongs.