老年2型糖尿病患者急性缺血性脑卒中凝血功能紊乱临床研究

Clinical study of coagulation dysfunction in elderly type 2 diabetic patients with acute ischemic stroke

目的探讨老年2型糖尿病(T2DM)患者急性缺血性脑卒中(ACI)凝血功能的变化情况。方法选取2018年1月至2020年12月惠州市第一人民医院收治的60例老年T2DM伴ACI患者作为A组,选择同期60例单纯T2DM患者作为B组,选择同期60例健康体检者作为C组。所有入选者均检测凝血功能指标,比较三组凝血功能指标。另外将A组患者根据Adama分型进行分组,比较不同梗死面积患者凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-D二聚体(D-D)]。结果A组PT、APTT均低于B、C组,FIB、D-D均高于B、C组,差异有统计学意义(P<0.05);B组PT、APTT均低于C组,FIB、D-D均高于C组,差异有统计学意义(P<0.05);大梗死组PT、APTT均低于小梗死组、腔隙性脑梗死组,FIB、D-D均高于小梗死组、腔隙性脑梗死组,差异有统计学意义(P<0.05);小梗死组PT、APTT均低于腔隙性脑梗死组,FIB、D-D均高于腔隙性脑梗死组,差异有统计学意义(P<0.05)。结论老年T2DM伴ACI存在明显的凝血功能紊乱,且随着梗死面积的增加凝血指标异常更加明显,可作为反映患者病情严重程度、评估预后的重要参考指标。

Objective To investigate the changes of coagulation function in elderly patients with type 2 diabetes(T2DM)with acute ischemic stroke(ACI).Methods From January 2018 to December 2020,60 elderly patients with T2DM and ACI who were admitted to the Huizhou First People′s Hospital were selected as group A,60 patients with pure T2DM in the same period were selected as group B,and 60 healthy patients in the same period were selected as group C.All candidates were tested for coagulation function indexes,and the coagulation function indexes of three groups were compared.In addition,patients in group A were grouped according to Adama classification,and the coagulation function indexes of patients with different infarct sizes were compared(prothrombin time[PT],activated partial thromboplastin time[APTT],fibrinogen[FIB]and DD dimer[DD]).Results PT and APTT of group A were lower than those of group B and group C,FIB and DD were higher than those of group B and group C,the differences were statistically significant(P<0.05).PT and APTT of group B were lower than group C,and FIB and DD were higher than group C,the differences were statistically significant(P<0.05);PT and APTT in the large infarction group were lower than those in the small infarction group and lacunar infarction group,FIB and DD were higher than those in the small infarction group and lacunar infarction group,the differences were statistically significant(P<0.05).The PT and APTT in the small infarction group were both lower than those in the lacunar infarction group,FIB and DD were higher than those in the lacunar infarction group,the differences were statistically significant(P<0.05).Conclusion There is obvious coagulation disorder in elderly T2DM with ACI,and the abnormal coagulation index becomes more obvious with the increase of infarct size,which can be used as an important reference index to reflect the severity of the patient′s condition and evaluate the prognosis.