伴下肢动脉病变的2型糖尿病患者血细胞相关参数的研究
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摘要
目的探讨伴下肢动脉粥样硬化性病变(LEAD)的2型糖尿病患者血小板平均体积(MPV)、血小板分布宽度(PDW)、红细胞分布宽度(RDW)的变化及临床意义。方法选取2型糖尿病患者330例,其中男168例,女162例,根据踝肱指数(ABI)分为2型糖尿病无LEAD组(A组)、2型糖尿病伴轻中度LEAD组(B组)、2型糖尿病伴重度LEAD组(C组),同时选择性别、年龄相匹配的健康体检者100例作为正常对照组(NC)。所有患者均测定血常规、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂、血压、超敏C-反应蛋白(hs-CRP)、血肌酐和尿酸。结果 2型糖尿病各组MPV、PDW、RDW均高于对照组(均P <0. 05),与无LEAD组相比,2型糖尿病伴LEAD组MPV、PDW、RDW显著升高(P <0. 05),差异具有统计学意义(P <0. 05)。Pearson相关分析显示MPV、PDW及RDW分别与血糖、血脂的相关指标呈正相关,logistic回归分析显示MPV、PDW、RDW、hs-CRP、HbA1c、LDL-C与LEAD呈正相关(P <0. 05),MPV、PDW、RDW是2型糖尿病患者下肢动脉病变的危险因素(OR值分别为1. 973、1. 736、1. 853,P <0. 05)。结论 2型糖尿病MPV、PDW、RDW水平升高的患者发生LEAD的风险增大,MPV、PDW、RDW可能是下肢动脉病变发生的危险因素。
Objective To investigate the variations and clinical significance of mean platelet volume( MPV),platelet distribution width( PDW) and red cell distribution width( RDW) in type 2 diabetic patients with lower extremity atherosclerotic disease( LEAD). Methods In this study,330 patients( 168 male and 162 female ones) diagnosed with type 2 diabetes mellitus were recruited. According to the ankle brachial index( ABI),all the patients were divided into three groups: patients without LEAD( Group A),patients with mild to moderate LEDA( group B),and severe LEAD( group C). And 100 healthy subjects served as control group. Blood routine,fasting plasma glucose( FPG),Hemoglobulin A1 c( HbA1c),blood pressure,high-sensitivity C-reactive protein( hs-CRP),blood lipids,serum creatinine and uric acid were all measured in the patients. Results MPV,PDW,RDW in all the patients with type 2 diabetes mellitus were significantly higher than those in the control group( P < 0. 05). Compared with the group without LEAD,MPV,PDW and RDW in the group with LEAD were significantly higher,with significant statistically difference( P < 0. 05). Pearson correlation analysis showed that MPV,PDW,RDW were positively correlated with the index of blood glucose and lipids. Logistic regression analyses indicated that the levels of MPV,PDW,RDW,hs CRP,HbA1c and low-density lipoprotein cholesterol( LDL-C) were significantly associated with lower extremity arterial disease in type 2 diabetes mellitus. Conclusions Patients with higher MPV,PDW and RDW levels were more likely to develop LEAD than those with lower levels. MPV,PDW and RDW were important risk factors for lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus.
Objective To investigate the variations and clinical significance of mean platelet volume( MPV),platelet distribution width( PDW) and red cell distribution width( RDW) in type 2 diabetic patients with lower extremity atherosclerotic disease( LEAD). Methods In this study,330 patients( 168 male and 162 female ones) diagnosed with type 2 diabetes mellitus were recruited. According to the ankle brachial index( ABI),all the patients were divided into three groups: patients without LEAD( Group A),patients with mild to moderate LEDA( group B),and severe LEAD( group C). And 100 healthy subjects served as control group. Blood routine,fasting plasma glucose( FPG),Hemoglobulin A1 c( HbA1c),blood pressure,high-sensitivity C-reactive protein( hs-CRP),blood lipids,serum creatinine and uric acid were all measured in the patients. Results MPV,PDW,RDW in all the patients with type 2 diabetes mellitus were significantly higher than those in the control group( P < 0. 05). Compared with the group without LEAD,MPV,PDW and RDW in the group with LEAD were significantly higher,with significant statistically difference( P < 0. 05). Pearson correlation analysis showed that MPV,PDW,RDW were positively correlated with the index of blood glucose and lipids. Logistic regression analyses indicated that the levels of MPV,PDW,RDW,hs CRP,HbA1c and low-density lipoprotein cholesterol( LDL-C) were significantly associated with lower extremity arterial disease in type 2 diabetes mellitus. Conclusions Patients with higher MPV,PDW and RDW levels were more likely to develop LEAD than those with lower levels. MPV,PDW and RDW were important risk factors for lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus.
引文
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[9] Zaccardi F,Rocca B,Pitocco D,et al. Platelet mean volume,distribution width,and count in type 2 diabetes,impaired fasting glucose,and metabolic syndrome:a meta-analysis[J]. Diabetes Metab Res Rev,2015,31(4):402-410. DOI:10. 1002/dmrr.2625.
[10]张志忠,肖红丽,王国兴,等.平均血小板体积联合红细胞分布宽度在急诊深静脉血栓诊断预测评估中的意义[J].中国医师杂志,2018,20(5):652-655. DOI:10. 3760/cma. j. issn.1008-1372. 2018. 05. 004.
[11] Balta S,Celik T,Mikhailidis DP,et al. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio[J]. Clin Appl Thromb Hemost,2016,22(5):405-411. DOI:10. 1177/1076029615569568.
[12] Gang L,Lifang W. Association of the Elevated Red Blood Cell Distribution Width with the Risk of Developing Diabetes Mellitus[J]. Intern Med,2016,55(15):1959-1965. DOI:10. 2169/internalmedicine. 55. 5956.
[13] Xanthopoulos A,Giamouzis G,Melidonis A,et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovasc Diabetol,2017,16(1):81. DOI:10. 1186/s12933-017-0563-1.
[14] Hamur H,Onk OA,Vuruskan E,et al. Determinants of Chronic Total Occlusion in Patients With Peripheral Arterial Occlusive Disease[J]. Angiology,2017,68(2):151-158. DOI:10. 1177/0003319716641827.
[2]沈文清,邢艳芳,黄丽,等.糖尿病肾病患者血流变与血小板参数的变化[J].中国综合临床,2016,32(7):622-625. DOI:10. 3760/cma. j. issn. 1008-6315. 2016. 07. 013.
[3] Hudzik B,Korzonek-Szlacheta I,Szkodziński J,et al. Association between multimorbidity and mean platelet volume in diabetic patients with acute myocardial infarction[J]. Acta Diabetol,2018,55(2):175-183. DOI:10. 1007/s00592-017-1079-6.
[4]中华医学会糖尿病学分会. 2型糖尿病患者合并下肢动脉病变的筛查及管理规范[J].中华糖尿病杂志,2013,5(2):82-88. DOI:10. 3760/cma. j. issn. 1674-5809. 2013. 02. 006.
[5]段纬喆,赵湜,毛红. 2型糖尿病膝下动脉病变患者介入治疗前后缺血动脉内氧化应激标志物的变化及意义[J].中国动脉硬化杂志,2018,26(2):176-180. DOI:10. 3969/j. issn. 1007-3949. 2018. 02. 012.
[6]张冰.血小板活化功能与冠心病的关系[J].医学综述,2012,18(5):654-656. DOI:10. 3969/j. issn. 1006-2084. 2012. 05. 005.
[7] Oshima S,Higuchi T,Okada S,et al. The Relationship Between Mean Platelet Volume and Fasting Plasma Glucose and Hb A1c Levels in a Large Cohort of Unselected Health Check-Up Participants[J]. J Clin Med Res,2018,10(4):345-350. DOI:10.14740/jocmr3361w.
[8] Agrawal J,Singh VB,Meena B,et al. Mean paltelet volume(MPV)the neglected marker of cardiovascular risk and glycosylated hemoglobin in diabetic patient[J]. Diabetes Metab Syndr,2017,11(2):109-112. DOI:10. 1016/j. dsx. 2016. 08. 014.
[9] Zaccardi F,Rocca B,Pitocco D,et al. Platelet mean volume,distribution width,and count in type 2 diabetes,impaired fasting glucose,and metabolic syndrome:a meta-analysis[J]. Diabetes Metab Res Rev,2015,31(4):402-410. DOI:10. 1002/dmrr.2625.
[10]张志忠,肖红丽,王国兴,等.平均血小板体积联合红细胞分布宽度在急诊深静脉血栓诊断预测评估中的意义[J].中国医师杂志,2018,20(5):652-655. DOI:10. 3760/cma. j. issn.1008-1372. 2018. 05. 004.
[11] Balta S,Celik T,Mikhailidis DP,et al. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio[J]. Clin Appl Thromb Hemost,2016,22(5):405-411. DOI:10. 1177/1076029615569568.
[12] Gang L,Lifang W. Association of the Elevated Red Blood Cell Distribution Width with the Risk of Developing Diabetes Mellitus[J]. Intern Med,2016,55(15):1959-1965. DOI:10. 2169/internalmedicine. 55. 5956.
[13] Xanthopoulos A,Giamouzis G,Melidonis A,et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus[J]. Cardiovasc Diabetol,2017,16(1):81. DOI:10. 1186/s12933-017-0563-1.
[14] Hamur H,Onk OA,Vuruskan E,et al. Determinants of Chronic Total Occlusion in Patients With Peripheral Arterial Occlusive Disease[J]. Angiology,2017,68(2):151-158. DOI:10. 1177/0003319716641827.