超重、肥胖对2型糖尿病患者凝血及代谢指标的影响

摘要

目的:了解超重、肥胖对2型糖尿病患者凝血及代谢紊乱的影响.方法:选择初诊为2型糖尿病的患者248例,根据人体质量指数(BMI)分为正常BMI对照组(95例)、超重组(87例)、肥胖组(66例),均测定血脂、血糖、空腹胰岛素等相关指标,计算胰岛素抵抗指数(HOMA - IR),并进行统计学处理.结果:与正常BMI对照组相比,超重组、肥胖组血浆纤维蛋白原(fg)[(3.37±0.55) g/L比(4.04±0.70) g/L比(5.20±0.69) g/L]、尿微量白蛋白(UMA)[(14.46±8.90) mg/g比(47.33±42.54) mg/g比(104.45±60.78) mg/g]、空腹血糖(FBG)[(7.15±0.97) mmol/L比(8.84±1.81) mmol/L比(10.06±2.28) mmol/L]、空腹胰岛素(FINS)[(10.09±8.21) IU/ml比(14.33±15.55) IU/ml比(19.69±10.86) IU/ml]、HOMA- IR[(3.19±2.59)比(5.51±5.38)比(8.48±4.62)]及血甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL - C)水平均明显升高,且随肥胖程度的增加而呈上升趋势,而血浆凝血酶原时间(PPT)[(13.33±0.69)s比(12.74±0.69)s比(11.43±0.53)s]、血浆活化部分凝血活酶时间(APTT)[(37.32±2.31)s比(36.55±2.41)s比(34.61±1.53)s]、HDL-C[(1.54±1.12) mmol/L比(1.27±0.41)mmol/L比(1.09±0.28) mmol/L]水平均明显降低,且随肥胖程度的加深而呈下降趋势(P均＜0.05).结论:超重及肥胖加重2型糖尿病凝血功能及代谢障碍,并加重胰岛素抵抗的程度,且此异常随肥胖程度的加深而更加严重.%Objective:To study influence of overweight and obesity on blood coagulation and metabolic disorders in patients with type 2 diabetes mellitus (T2DM).Methods:total of 248 preliminary diagnosed T2DM patients were selected.According to body mass index (BMI),they were divided into normal BMI control group (n =95),overweight group (n =87) and obesity group (n =66).Blood lipids,blood glucose and fasting insulin (FINS) were measured in all patients and homeostasis model-insulin resistance index (HOMA- IR) was calculated then.Statistical analysis was performed.Results:Compared with normal BMI control group,there were significant increase in fibrinogen [ (3.37 ± 0.55) g/L vs.(4.04 ± 0.70) g/L vs.(5.20 ± 0.69) g/L],urine microalbumin [ (14.461 8.90) mg/g vs.(47.33 ± 42.54) mg/g vs.(104.45 ± 60.78) mg/g],fasting blood glucose [ (7.15 ± 0.97) mmol/L vs.(8.84± 1.81) mmol/L vs.(10.06± 2.28) mmol/L],FINS [(10.09 ± 8.21) IU/ml vs.(14.33 ± 15.55) IU/ml vs.(19.69± 10.86) IU/ml],HOMA- IR [ (3.19 ± 2.59) vs.(5.51 ± 5.38) vs.(8.48 ± 4.62)],TG,TC and LDL- C levels in overweight group and obesity group,and the more BMI patients were,the higher these indicators were; There were significant decrease in plasma prothrombin time [ ( 13.33 ± 0.69) s vs.( 12.74 ± 0.69) s vs.( 11.43 ± 0.53)s],activated partial thromboplastin time [ (37.32 ± 2.31) s vs.(36.55 ± 2.41) s vs.(34.61 ± 1.53) s] and HDL-C [ (1.54 ± 1.12) mmol/L vs.(1.27 ± 0.41) mmol/L vs.(1.09 ± 0.28) mmol/L] in overweight group and obesity group (P＜0.05 all).Conclusion:Overweight and obesity aggravate coagulation and metabolic disorders in patients with type 2 diabetes mellitus.It also aggravates degree of insulin resistance,the more BMI patients are,the more serious they are.