2型糖尿病患者血清同型半胱氨酸与凝血指标致动脉粥样硬化的作用

摘要

Objective To analyze the relationship between plasma homocysteine( HCY) and coagulation index in patients with type 2 diabetes mellitus(T2DM) and their influences on carotid atherosclerotic plaque formation. Methods Sixty patients with type 2 diabe-tes were divided into plaque group(n=39) and non-plaque group(n=21) according to the results of the bilateral carotid ultrasonogra-phy examination. Twenty-four normal controls were chosen as control group. Fasting blood glucose( FPG) , plasma glycated hemoglobin (HbA1c), homocysteine(HCY) and coagulation indexes(PT,APTT,TT,INR,FIB,D-Dimer) were measured and compared among three groups. The correlations between the indicators and the influential factors of carotid atherosclerotic plaque formation were analyzed by Logistic regression analysis. Results Levels of HCY,FPG,HbA1c in non-plaque group were higher than in normal control group (P<0. 05),but the differences of PT,APTT,TT,INR,FIB D-Dimer were not significant between normal control group and non-plaque group. Levels of HCY,FPG,HbA1c,FIB,D-Dimer in plaque group were higher than in normal control group(P <0. 05),but the differences of PT, INR, TT, APTT were not significant between normal control group and plaque group. Compared with non-plaque group, HCY, FPG, HbA1c and coagulation index showed no significant changes in plaque group. Significant correlations between HCY and PT, APTT, TT, INR, FIB, D-Dimer, FPG, HbA1c were not found. HbA1c was negatively correlated with PT, APTT, INR (P<0. 05). Logistic regression analysis revealed that increase of HCY(OR=1. 187,95%CI 1. 009-1. 398,P=0. 039) and D-Dimer (OR=1. 074,95%CI 1. 021-1. 130,P=0. 006) were independent risk factors for carotid atherosclerotic plaque formation in patients with type 2 diabetes mellitus. Conclusion Plasma HCY level and abnormal fibrinolytic function may be the risk factors of carotid atherosclerotic plaque formation in patients with type 2 diabetes mellitus. Early detection and intervention of hyperhomocystinemia and abnormal fibrinolytic function may have important significance in the prevention of atherosclerosis.%目的：分析2型糖尿病(T2DM)患者同型半胱氨酸(HCY)、凝血指标的关系及其对颈动脉粥样硬化斑块形成的影响。方法60例2型糖尿病患者以颈动脉超声结果为标准,分为无斑块组(n=21)及有斑块组(n=39),同时,选取24例健康体检者为正常对照组,比较各组间空腹血糖( FPG)、糖化血红蛋白( HbA1c)、同型半胱氨酸( HCY)及凝血指标( PT,APTT,TT, INR,FIB,D-Dimer)的差异,分析各指标之间的相关性,并对影响颈动脉粥样硬化斑块形成的危险因素进行Logistic回归分析。结果与正常对照组比较,T2DM无斑块组HCY、FPG、HbA1c均显著增高(P<0.05),凝血指标的变化不具有统计学意义；T2DM有斑块组HCY、FPG、HbA1c、FIB、D-Dimer均显著增高(P<0.05),其余凝血指标PT、INR、TT、APTT的变化不具有统计学意义。与T2DM无斑块组比较,T2DM有斑块组HCY、FPG、HbA1c及凝血指标的变化不具有统计学意义。未发现HCY与各凝血指标及FPG、HbA1c之间有显著相关性,HbA1c与PT、APTT、INR之间呈显著负相关(均P<0.05),Logistic回归分析表明HCY(OR=1.187,95%CI 1.009-1.398,P=0.039)及D-Dimer(OR=1.074,95%CI 1.021-1.130,P=0.006)水平升高是2型糖尿病患者颈动脉粥样硬化斑块形成的独立危险因素。结论血浆HCY水平及纤溶功能异常可能是导致糖尿病颈动脉粥样硬化斑块形成的危险因素,及早发现并干预高HCY血症及纤溶异常可能对预防动脉粥样硬化有重要意义。