早期糖尿病肾病患者血栓风险分析
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摘要
目的分析早期糖尿病肾病患者血栓风险及影响因素。方法选取2017年5月～2018年5月在河北省沧州中西医结合医院(以下简称"我院")内分泌科就诊的2型糖尿病患者120例,其中尿白蛋白定量/尿肌酐(ACR)正常[ACR<2.5(男)/3.5(女)mg/mmol]的60例作为2型糖尿病组(T2DM组),ACR在2.5(男)/3.5(女)～30.0 mg/mmol之间的60例作为早期糖尿病肾病组(EDN组)。另选取我院健康体检者30名作为对照组(NC组)。检测各组代谢指标,包括空腹血糖(FPG)、餐后2 h血糖(2hPBG)、糖化血红蛋白(HbA_(1c))、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG),以及血栓弹力图(TEG)的R值、K值、CI值、MA值、Angle角值,评估血栓形成的危险因素。结果与NC组比较,T2DM组及EDN组FPG、2hPBG、HbA1c水平均升高(P <0.05);与T2DM组比较,EDN组FPG、2hPBG、HbA1c水平均升高(P <0.05)。与NC组比较,T2DM组及EDN组TG、TC、LDL-C水平均升高(P <0.05),但T2DM组与EDN组TG、TC、LDL-C水平比较差异无统计学意义(P> 0.05)。与NC组比较,T2DM组及EDN组的R值、K值均降低,Angle角值、MA值、CI值均升高,差异有统计学意义(P <0.05);与T2DM组比较,EDN组R值、K值下降,Angle角值、MA值、CI值上升,差异有统计学意义(P <0.05)。直线相关分析显示R值、K值与ACR呈负相关(r=-0.423、-0.517,均P <0.01),Angle角值、MA值、CI值与ACR呈正相关(r=0.683、0.742、0.669,均P <0.01)。Logistic回归分析显示:糖尿病病程、血脂异常、吸烟史、ACR升高为早期糖尿病肾病患者血栓风险的独立危险因素(OR=2.423、1.986、2.103、4.358,均P <0.05)。结论糖尿病患者在未出现蛋白尿前,血栓风险已经高于健康成人。早期糖尿病肾病患者血栓风险高于单纯糖尿病患者。早期糖尿病肾病患者的血栓风险与糖尿病病程、血脂异常、吸烟史、ACR升高相关。
Objective To study the risk and influencing factors of thrombosis in patients with early diabetic nephropathy. Methods One hundred and twenty patients with type 2 diabetes that admitted to Endocrinology Department of Cangzhou Hospital of Integrated Chinese and Western Medicine( "our hospital" for short) from May 2017 to May 2018 were selected, with 60 cases ACR<2.5(male)/3.5(female) mg/mmol as type 2 diabetes group(T2DM group), 60 cases ACR from 2.5(male)/3.5(female) mg/mmol to 30.0 mg/mmol as early diabetic nephropathy group(EDN group). And 30 cases of health check-up in our hospital were taken as the control group(NC group). The metabolism indexes of each group were detected as fasting blood-glucose(FPG), postprandial 2 h plasma glucose(2 hPBG), glycosylated hemoglobin(HbA_(1 c)), total cholestero(TC), low-density lipoprotein cholesterol(LDL-C), triacylglycerol(TG), and thrombelastogram(TEG) indexes as R value, K value, CI value, MA value, Angle angle value to assess the risk of thrombosis. Results Compared with the NC group, the levels of FPG, 2 hPBG, HbA_(1 c)of T2 DM group and EDN group increased(P < 0.05);compared with the T2DM group, the levels of FPG, 2 hPBG, HbA_(1 c)of EDN group increased(P < 0.05). Compared with the NC group, the levels of TG, TC, LDL-C of T2DM group and EDN group increased(P < 0.05), while there was no significant difference in the levels of TG, TC, LDL-C between T2DM group and EDN group(P > 0.05). Compared with the NC group, the R value and K value of T2DM group and EDN group decreased, while the Angle value, MA value and CI value increased, and the differences were statistically significant(P < 0.05); compared with the T2DM group, the R value and K value of the EDN group decreased, while the Angle value, MA value and CI value increased, the differences were statistically significant(P < 0.05). Linear correlation analysis showed that ACR was negatively correlated with R value and K value(r =-0.423,-0.517, all P < 0.01), ACR was positively correlated with Angle value, MA value and CI value(r = 0.683, 0.742, 0.669, all P < 0.01). Logistic regression analysis showed that the course of diabetes, dyslipidemia, smoking history, and ACR increase were independent risk factors for thrombosis in patients with early diabetic nephropathy(OR = 2.423, 1.986, 2.103, 4.358, all P < 0.05). Conclusion Diabetics have a higher risk of blood clots than healthy adults before proteinuria. Patients with early diabetic nephropathy have a higher risk of thrombosis than those with simple diabetes. The risk of thrombosis in patients with diabetic nephropathy is related to the course of diabetes, smoking history, dyslipidemia, and elevated ACR.
Objective To study the risk and influencing factors of thrombosis in patients with early diabetic nephropathy. Methods One hundred and twenty patients with type 2 diabetes that admitted to Endocrinology Department of Cangzhou Hospital of Integrated Chinese and Western Medicine( "our hospital" for short) from May 2017 to May 2018 were selected, with 60 cases ACR<2.5(male)/3.5(female) mg/mmol as type 2 diabetes group(T2DM group), 60 cases ACR from 2.5(male)/3.5(female) mg/mmol to 30.0 mg/mmol as early diabetic nephropathy group(EDN group). And 30 cases of health check-up in our hospital were taken as the control group(NC group). The metabolism indexes of each group were detected as fasting blood-glucose(FPG), postprandial 2 h plasma glucose(2 hPBG), glycosylated hemoglobin(HbA_(1 c)), total cholestero(TC), low-density lipoprotein cholesterol(LDL-C), triacylglycerol(TG), and thrombelastogram(TEG) indexes as R value, K value, CI value, MA value, Angle angle value to assess the risk of thrombosis. Results Compared with the NC group, the levels of FPG, 2 hPBG, HbA_(1 c)of T2 DM group and EDN group increased(P < 0.05);compared with the T2DM group, the levels of FPG, 2 hPBG, HbA_(1 c)of EDN group increased(P < 0.05). Compared with the NC group, the levels of TG, TC, LDL-C of T2DM group and EDN group increased(P < 0.05), while there was no significant difference in the levels of TG, TC, LDL-C between T2DM group and EDN group(P > 0.05). Compared with the NC group, the R value and K value of T2DM group and EDN group decreased, while the Angle value, MA value and CI value increased, and the differences were statistically significant(P < 0.05); compared with the T2DM group, the R value and K value of the EDN group decreased, while the Angle value, MA value and CI value increased, the differences were statistically significant(P < 0.05). Linear correlation analysis showed that ACR was negatively correlated with R value and K value(r =-0.423,-0.517, all P < 0.01), ACR was positively correlated with Angle value, MA value and CI value(r = 0.683, 0.742, 0.669, all P < 0.01). Logistic regression analysis showed that the course of diabetes, dyslipidemia, smoking history, and ACR increase were independent risk factors for thrombosis in patients with early diabetic nephropathy(OR = 2.423, 1.986, 2.103, 4.358, all P < 0.05). Conclusion Diabetics have a higher risk of blood clots than healthy adults before proteinuria. Patients with early diabetic nephropathy have a higher risk of thrombosis than those with simple diabetes. The risk of thrombosis in patients with diabetic nephropathy is related to the course of diabetes, smoking history, dyslipidemia, and elevated ACR.
引文
[1]纪立农,宁光.糖化血红蛋白[M].北京:人民卫生出版社,2010:29.
[2]单巧云,魏倩萍,刘墨默.血栓弹力图在2型糖尿病合并冠心病患者中的应用[J].中国现代药物应用,2017,11(8):105-107.
[3]敖强国,邹慧,马强,等.慢性肾脏病对高龄患者血栓弹力图检测的影响[J].中华保健医学杂志,2011,13(1):15-18.
[4]中华医学会糖尿病分会.中国2型糖尿病防治指南(2017年版)[M].北京:北京大学医学出版社,2018.
[5]马莉,程国杰,郭丽敏,等.应用血栓弹力图评价糖尿病对急性冠状动脉综合征患者血小板抑制率的影响[J].中国心血管杂志,2013,18(6):449-451.
[6]张春玉,李小霞,邓琼.血栓弹力图在老年急性冠脉综合征患者抗血小板治疗有效性与安全性评估中的应用[J].中国医学创新,2018,15(16):27-30.
[7]易思华,林婧,罗强军,等.健康成人血栓弹力图参考范围的确立[J].西部医学,2016,28(2):266-269.
[8] Dubin R,Cushman M,Folsom AR,et al. Kidney function and multiple hemostatic markers:cross sectional associations in the multi-ethnic study of atherosclerosis[J]. BMC Nephrol,2011,12:3.
[9]薛峥,朱晓霞,王秀杰.凝血功能障碍患者血栓弹力图的临床应用[J].医学综述,2017,23(15):3097-3101.
[10]汤晓静,郁胜强.血栓弹力图在评价肾病综合征患者高凝状态中的作用[J].中国全科医学,2011,14(17):1890-1892.
[11]朱光俊,金先富,张钦怡,等.血栓弹力图与常规凝血检测项目的相关性分析[J].中国卫生检验杂志,2018,28(9):1140-1142.
[12]范彦琦,覃炳军,何瑞玲,等.血栓弹力图评价多发伤患者凝血功能障碍[J].现代医院,2017,17(3):444-446,449.
[13]曾龙宏,祁妙华,胡晓婧.血栓弹力图与常规凝血指标在DIC患者血液制品输注中的指导价值[J].中国当代医药,2017,24(17):24-26.
[14]孙沛.2型糖尿病合并肾病患者中血栓弹力图的应用分析[J].当代医学,2015,21(12):87-88.
[15]刘帅,张婧婧,彭小婉,等血栓弹力图与常规凝血检测指导临床输血的相关性分析[J].中国医学创新,2016,13(11):37-40.
[16]姚敏,吴秀继,何启军,等.2型糖尿病患者血栓弹力图与糖化血红蛋白C-肽和胰岛素的相关性研究[J].中国糖尿病杂志,2016,24(8):705-707.
[17]王喜凤,万亚存.糖尿病肾病患者血液高凝状态与蛋白尿的关系研究[J].中外医疗,2014(33):126-127.
[18]刘蕾,乐伟波,徐孝东,等.特发性膜性肾病凝血功能障碍与血小板功能亢进的关联[J].肾脏病与透析肾移植杂志,2017,26(2):108-112.
[19]王向托,赵讯.高凝状态与糖尿病肾病患者心血管事件的关系[J].中国老年学杂志,2016,36(1):245-247.
[20]杨云山,黄少兴,陈潇楷.血栓弹力图与常规凝血检验在慢性肾脏病中应用比较[J].中国处方药,2018,16(5):133-134.
[21]施芳红,李浩,逄晓云,等.血栓弹力图评价慢性肾脏病患者高凝状态的危险因素分析[J].中国药师,2018,21(2):282-285.
[22]葛蕾.肾脏透析患者凝血和纤溶功能改变的临床观察[J].中国医药科学,2017,7(13):226-228.
[23]张利,赵孝生,蔡婷婷,等.血小板相关参数及血栓弹力图检测对糖尿病患者血管病变的早期诊断价值探讨[J].国际检验医学杂志,2014,35(5):574-575.
[24]曹娟,徐加勤,毛礼萍,等.血小板相关参数和血栓弹力图各指标与糖尿病血管并发症发生和发展的相关性[J].中国慢性病预防与控制,2015,23(4):291-293.
[25]高逸之,王志良,李超男,等.心肌梗死合并糖尿病患者血栓弹力图变化探讨[J].中国医药导报,2018,15(2):50-53.
[26]赵玉霞,刘巧巧.双联抗血小板聚集疗法用于糖尿病合并脑梗死的临床治疗作用[J].中国当代医药,2017,24(23):34-36.
[27]吴鸿谊,吕海辰,钱菊英,等.血栓弹力图评价吸烟对双联抗血小板药物作用的影响[J].上海医学,2018,41(1):9-13.
[28]王焱,张雪梅.吸烟与凝血纤溶功能相关性研究[J].四川医学,2010,31(10):1544-1546.
[2]单巧云,魏倩萍,刘墨默.血栓弹力图在2型糖尿病合并冠心病患者中的应用[J].中国现代药物应用,2017,11(8):105-107.
[3]敖强国,邹慧,马强,等.慢性肾脏病对高龄患者血栓弹力图检测的影响[J].中华保健医学杂志,2011,13(1):15-18.
[4]中华医学会糖尿病分会.中国2型糖尿病防治指南(2017年版)[M].北京:北京大学医学出版社,2018.
[5]马莉,程国杰,郭丽敏,等.应用血栓弹力图评价糖尿病对急性冠状动脉综合征患者血小板抑制率的影响[J].中国心血管杂志,2013,18(6):449-451.
[6]张春玉,李小霞,邓琼.血栓弹力图在老年急性冠脉综合征患者抗血小板治疗有效性与安全性评估中的应用[J].中国医学创新,2018,15(16):27-30.
[7]易思华,林婧,罗强军,等.健康成人血栓弹力图参考范围的确立[J].西部医学,2016,28(2):266-269.
[8] Dubin R,Cushman M,Folsom AR,et al. Kidney function and multiple hemostatic markers:cross sectional associations in the multi-ethnic study of atherosclerosis[J]. BMC Nephrol,2011,12:3.
[9]薛峥,朱晓霞,王秀杰.凝血功能障碍患者血栓弹力图的临床应用[J].医学综述,2017,23(15):3097-3101.
[10]汤晓静,郁胜强.血栓弹力图在评价肾病综合征患者高凝状态中的作用[J].中国全科医学,2011,14(17):1890-1892.
[11]朱光俊,金先富,张钦怡,等.血栓弹力图与常规凝血检测项目的相关性分析[J].中国卫生检验杂志,2018,28(9):1140-1142.
[12]范彦琦,覃炳军,何瑞玲,等.血栓弹力图评价多发伤患者凝血功能障碍[J].现代医院,2017,17(3):444-446,449.
[13]曾龙宏,祁妙华,胡晓婧.血栓弹力图与常规凝血指标在DIC患者血液制品输注中的指导价值[J].中国当代医药,2017,24(17):24-26.
[14]孙沛.2型糖尿病合并肾病患者中血栓弹力图的应用分析[J].当代医学,2015,21(12):87-88.
[15]刘帅,张婧婧,彭小婉,等血栓弹力图与常规凝血检测指导临床输血的相关性分析[J].中国医学创新,2016,13(11):37-40.
[16]姚敏,吴秀继,何启军,等.2型糖尿病患者血栓弹力图与糖化血红蛋白C-肽和胰岛素的相关性研究[J].中国糖尿病杂志,2016,24(8):705-707.
[17]王喜凤,万亚存.糖尿病肾病患者血液高凝状态与蛋白尿的关系研究[J].中外医疗,2014(33):126-127.
[18]刘蕾,乐伟波,徐孝东,等.特发性膜性肾病凝血功能障碍与血小板功能亢进的关联[J].肾脏病与透析肾移植杂志,2017,26(2):108-112.
[19]王向托,赵讯.高凝状态与糖尿病肾病患者心血管事件的关系[J].中国老年学杂志,2016,36(1):245-247.
[20]杨云山,黄少兴,陈潇楷.血栓弹力图与常规凝血检验在慢性肾脏病中应用比较[J].中国处方药,2018,16(5):133-134.
[21]施芳红,李浩,逄晓云,等.血栓弹力图评价慢性肾脏病患者高凝状态的危险因素分析[J].中国药师,2018,21(2):282-285.
[22]葛蕾.肾脏透析患者凝血和纤溶功能改变的临床观察[J].中国医药科学,2017,7(13):226-228.
[23]张利,赵孝生,蔡婷婷,等.血小板相关参数及血栓弹力图检测对糖尿病患者血管病变的早期诊断价值探讨[J].国际检验医学杂志,2014,35(5):574-575.
[24]曹娟,徐加勤,毛礼萍,等.血小板相关参数和血栓弹力图各指标与糖尿病血管并发症发生和发展的相关性[J].中国慢性病预防与控制,2015,23(4):291-293.
[25]高逸之,王志良,李超男,等.心肌梗死合并糖尿病患者血栓弹力图变化探讨[J].中国医药导报,2018,15(2):50-53.
[26]赵玉霞,刘巧巧.双联抗血小板聚集疗法用于糖尿病合并脑梗死的临床治疗作用[J].中国当代医药,2017,24(23):34-36.
[27]吴鸿谊,吕海辰,钱菊英,等.血栓弹力图评价吸烟对双联抗血小板药物作用的影响[J].上海医学,2018,41(1):9-13.
[28]王焱,张雪梅.吸烟与凝血纤溶功能相关性研究[J].四川医学,2010,31(10):1544-1546.