高血压合并2型糖尿病患者血小板参数、凝血四项指标的观察

发布时间：2018-05-27 19:04

本文选题：高血压 + 2型糖尿病　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:原发性高血压合并2型糖尿病(Type 2 diabetes mellitus)比例较高,高血压和糖尿病都可引起机体多处靶器官损害,尤其是增加发生心脑血管血栓事件的风险。血小板异常、凝血、纤溶系统改变均可导致患者形成血栓前状态,并进而增加发生心脑血管血栓事件的风险。本研究即探讨原发性高血压及高血压合并2型糖尿病糖患者血小板参数、凝血指标水平的关系及临床意义,同时检测AT-Ⅲ、D-D及VWF水平探讨血管内皮功能损伤与凝血的关系。方法:选择2016年1月到2016年10月在任丘市华北石油管理局总医院心内一科收治的高血压合并T2DM(Type 2 diabetes mellitus 2型糖尿病)患者(高血压T2DM组,n=50)和不伴糖尿病的原发性高血压患者(高血压组,n=50)。另选取同期进行健康体检的25例作为对照组。采用全自动生化分析仪检测血糖血脂指标;采用SYSMEX五分类血液分析仪XE-5000检测PLT(platelet count血小板计数)、MPV(Mean platelet volume平均血小板体积)、PDW(Platelet distribution width血小板分布宽度)、P-LCR(Large platelet ratio大血小板率)等血小板参数;采用法国STAGO COMPact全自动血凝分析仪进行PT(prothrombin time凝血酶原时间)、APTT(Activated partial thromboplastin time活化部分凝血活酶时间)、TT(Thrombin time凝血酶时间)、FIB(Fibrinogen纤维蛋白原)等凝血相关指标;采用发色底物法检测AT-Ⅲ(Antithrombin III抗凝血酶-Ⅲ)水平,采用免疫比浊法检测D-D(D-two polymer D-二聚体)、VWF(Von Willebrand factor血管性假血友病因子)水平。结果:1 3组性别、年龄、吸烟人群比例无显著性差异(P0.05);与对照组比较,高血压组及高血压T2DM组SBP(systolic pressure收缩压)、DBP(diastolic pressure舒张压)、MABP(mean arterial pressure mean arterial pressure)、脉压及BMI(Body mass index体质量指数)明显升高(P0.01),但高血压组及高血压T2DM组2组间无显著性差异。2与对照组比较,高血压组及高血压T2DM组FPG(Fasting blood glucose空腹血糖)、2hPG(Postprandial 2 h blood glucose餐后2 h血糖)、HbAlc(glycosylated hemoglobin糖化血红蛋白)、TC(total cholesterol总胆固醇)、TG(triglyceride甘油三酯)、LDL-C(Low density lipoprotein cholesterol低密度脂蛋白胆固醇)明显升高,HDL-C(High density lipoprotein cholesterol高密度脂蛋白胆固醇)明显降低(P0.05或P0.01);与高血压组比较,高血压T2DM组FPG、2hPG、HbAlc、TC、TG、LDL-C明显升高,HDL-C明显降低(P0.05或P0.01)。3与对照组比较,高血压组及高血压T2DM组PLT、MPV、PDW、P-LCR明显升高(P0.01);与高血压组比较,高血压T2DM组PLT、MPV、PDW、P-LCR明显升高(P0.01)。4与对照组比较,高血压组及高血压T2DM组PT、APTT明显降低,FIB明显升高(P0.01);与高血压组比较,高血压T2DM组PT、APTT明显降低,FIB明显升高(P0.01)。TT在3组间无显著性差异(P0.05)。5与对照组比较,高血压组及高血压T2DM组AT-Ⅲ明显降低,D-D、VWF明显升高(P0.01);与高血压组比较,高血压T2DM组AT-Ⅲ明显降低,D-D、VWF明显升高(P0.05或P0.01)。结论:1血小板参数及凝血四项检测可灵敏地反映原发性高血压及合并T2DM患者的凝血功能是否存在异常。2高血压合并T2DM患者较原发性高血压患者凝血异常更为明显。3原发性高血压及合并T2DM患者存在血管内皮细胞损伤和血液高凝状态,检测AT-Ⅲ、D-D、VWF等PTS分子标志物可为防治高血压合并T2DM患者发生血栓事件提供一定的依据。
[Abstract]:Objective: the proportion of primary hypertension with type 2 diabetes (Type 2 diabetes mellitus) is higher. Hypertension and diabetes can cause multiple target organ damage, especially the risk of cardio cerebral vascular thrombosis. Abnormal thrombocytopenia, coagulation and fibrinolysis can cause the patients to form prethrombotic state and then increase their hair. The risk of cardio cerebral vascular thrombosis. This study was to explore the relationship and clinical significance of platelet parameters, blood coagulation indexes and AT- III, D-D and VWF levels in patients with essential hypertension and hypertension combined with type 2 diabetic glucose. Methods: the relationship between vascular endothelial dysfunction and coagulation was examined. Methods: from January 2016 to October 2016, Hypertension combined with T2DM (Type 2 diabetes mellitus 2 diabetes) patients (hypertension T2DM, n=50) and non diabetic primary hypertension patients (hypertension group, n=50) were admitted to the heart of the General Hospital of Renqiu Petroleum Administration General Hospital of North China National Petroleum Administration, and 25 cases of healthy health examination were selected as control group at the same time. The blood glucose and blood lipid indexes were measured by the instrument, and the SYSMEX five classification blood analyzer XE-5000 was used to detect the PLT (platelet count platelet count), MPV (Mean platelet volume mean platelet volume), PDW (Platelet distribution platelet distribution width) and other platelet parameters. PT (prothrombin time prothrombin time), APTT (Activated partial thromboplastin time activated partial thromboplastin time), TT (Thrombin time thrombin time), FIB (fibrinogen) and other coagulation related indexes were performed by full automatic hemagglutination analyzer. The level of D-D (D-two polymer D- two polymer) and VWF (Von Willebrand factor vascular pseudomophilic factor) was detected by immunoturbidimetry. Results: there was no significant difference in the proportion of sex, age, and smoking population in the 13 groups (P0.05), and the hypertension and the SBP systolic pressure of the T2DM group of the hypertension (systolic) were compared with the control group. Diastolic pressure (diastolic pressure), MABP (mean arterial pressure mean arterial pressure), pulse pressure and BMI (Body mass index body mass index) obviously increased (P0.01), but there was no significant difference between the 2 groups of hypertension group and hypertension group. Blood glucose postprandial 2 h blood sugar), HbAlc (glycosylated hemoglobin glycated hemoglobin), TC (total cholesterol total cholesterol), TG (triglyceride triglyceride), LDL-C (low density lipoprotein cholesterol) obviously. Compared with the hypertension group, the FPG, 2hPG, HbAlc, TC, TG, LDL-C in the hypertensive T2DM group increased significantly, and the HDL-C significantly decreased (P0.05 or P0.01). The hypertension group and the hypertension group were significantly higher than those in the control group. Compared with the control group, the PT, APTT and FIB increased significantly in the hypertension group and the T2DM group (P0.01). Compared with the hypertension group, the PT, APTT, and FIB significantly increased in the hypertension group, and the FIB significantly increased (P0.01).TT in the 3 groups (P0.05) was significantly lower than the control group. Higher (P0.01), compared with hypertension group, AT- III in T2DM group was significantly lower in hypertension group, D-D and VWF was significantly increased (P0.05 or P0.01). Conclusion: 1 platelet parameters and four blood coagulation tests can sensitively reflect the coagulation function in patients with primary hypertension and T2DM patients with abnormal.2 hypertension combined with coagulability in patients with essential hypertension than in patients with essential hypertension. There is often more obvious.3 primary hypertension and T2DM patients with vascular endothelial cell injury and hypercoagulable state, and the detection of AT- III, D-D, VWF and other PTS molecular markers can provide a basis for the prevention and treatment of hypertension complicated with T2DM patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R587.1

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