胰岛素强化治疗对初诊2型糖尿病患者凝血功能的影响研究

发布时间：2018-06-02 10:12

本文选题：2型糖尿病 + 初诊　；参考：《新乡医学院》2015年硕士论文

【摘要】：背景糖尿病是一种因胰岛素分泌和(或)作用缺陷所引起的以慢性血葡萄糖水平增高为主要特征的代谢性疾病。该病为临床常见病和多发病之一,近年来随着人们生活水平提高、人口老龄化以及生活方式改变,糖尿病的患病率明显升高,患病人数也逐年攀升。有统计显示,与过去20年相比糖尿病患者上升了4倍之多。在我国,截至目前糖尿病患者多达9200万人以上,位居全球之首。2型糖尿病约占糖尿病患者总人数的90%以上,据报道,每10s就有一位糖尿病患者死于糖尿病相关并发症,其死亡率接近于艾滋病。糖尿病主要危害患者的心、脑、肾、神经、血管、皮肤等,且上述危害常常在不知不觉中发生,其严重性已引起了人们的广泛关注。研究指出,40岁初诊2型糖尿病患者的平均寿命与普通人群相比要减少8年,其中心血管事件为该病的第一位死亡原因。有报道显示,糖尿病患者冠心病的发生率约为65%,心血管事件发生率约为普通人群的2-4倍,而糖尿病伴发心血管并发症患者中死于急性心肌缺血并发症的约占75%。大量研究证实,2型糖尿病可造成神经、血管、以及多系统、多组织损伤,相关并发症多,且脑血管疾病、高血压、冠心病和周围血管疾病的发病风险较高。国内外相关研究证实,糖尿病患者多因血管病变致残或死亡其中约80%的患者死于血栓疾病。2型糖尿病患者抗凝及纤溶活性降低、凝血活性亢进,出现凝血——纤溶功能紊乱,血液处于高凝状态,伴有并发症时其血液高凝状态更加明显。目前,如何通过早期干预缓解2型糖尿病患者的高凝血状态,有效改善糖尿病患者的凝血功能,已成为临床医务人员面临的重要问题。目的探讨胰岛素强化治疗对初诊2型糖尿病(Type 2 diabetes mellitus,T2DM)患者凝血功能的影响。对象与方法选取于2013年9月～2014年9月入我院内分泌科就诊的2型糖尿病患者60例,糖尿病诊断及分类符合1999年世界卫生组织(WHO)标准,均为新诊断2型糖尿病患者,将其设为治疗组；以同期入我院接受体检的健康人60例作为对照,设为对照组。空腹抽血测定FBG、2PBG、HbA1c、血脂、胰岛素和凝血指标：凝血酶原时间、部分活化凝血活酶时间和国际标准化比值。对治疗组患者行胰岛素强化治疗3个月,之后停用外源性胰岛素,空腹抽血测定其凝血指标、HbA1c、FBG、2PBG、血脂。计算胰岛素β细胞功能(Homaβ)及胰岛素抵抗指数IR (HomaIR)、于治疗前后比较治疗组上述指标的变化情况,并将治疗组上述指标与对照组进行比较。结果治疗组和对照组的性别、年龄、体质指数(BMI)等一般资料无统计学差异(P0.05),具有可比性。经胰岛素强化治疗前治疗组患者的FBG、2PBG、HbA1c、胆固醇(Cholesterol,TC)、低密度脂蛋白(Low-density lipoprotein,LDL)、甘油三酯(Triglyceride,TG)明显高于对照组(P0.05),高密度脂蛋白(High density lipoprotein, HDL)和Homaβ下降,HomaIR升高,凝血酶原时间(Prothrombin time, PT)、部分活化凝血活酶时间(Activated partial thromboplastin time, APTT)和国际标准化比值(International normalized ratio,INR)均明显缩短,凝血活酶时间(Thromboplastin time,TT)则无明显改变。经治疗后治疗组患者的FBG、2PBG、 HbA1c、TG均明显下降,HDL升高,Homaβ和HomaIR明显改善,PT、APTT和INR等凝血指标均明显延长,与该组治疗前比较均有显著性差异(P0.05),但其FBG、2PBG、HbAlc、TG、LDL仍高于对照组,Homaβ下降,HomaIR升高,PT、APTT和INR等凝血指标明显缩短,比较差异均有统计学意义(P0.05)。结论初诊2型糖尿病患者存在高凝血状态,经胰岛素强化治疗可有效改善其凝血功能；经胰岛素强化治疗后患者的凝血功能未恢复至正常水平,可能与其血糖血脂水平未完全恢复正常有关。
[Abstract]:Background diabetes is a metabolic disease characterized by high levels of chronic blood glucose caused by insulin secretion and or (or) deficiency. This disease is one of the common and frequently occurring diseases. In recent years, the prevalence of diabetes is significantly increased with the improvement of people's living standards, the aging of the population and the change of lifestyle. The number of patients also rises year by year. There are statistics showing that diabetic patients have risen more than 4 times as much as the past 20 years. In China, up to now, there are more than 92 million diabetic patients, more than 90% of the total number of diabetic patients in the world are the first.2 type diabetes, and one diabetic patient per 10s is reported to have died of diabetes related The mortality rate is close to AIDS. Diabetes mainly endangering patients' heart, brain, kidney, nerve, blood vessel, skin and so on, and the above harm often occurs unwittingly, and its severity has caused widespread concern. The study indicates that the average life span of 40 year old patients with type 2 diabetes should be reduced by 8 years compared with those of the general population. The incidence of cardiovascular events is the first cause of death in the disease. It is reported that the incidence of coronary heart disease in diabetic patients is about 65%, the incidence of cardiovascular events is about 2-4 times that of the general population, and diabetes associated with complications of acute myocardial ischemia in patients with cardiovascular complications has been confirmed by a large number of 75%. studies, and type 2 diabetes can cause God. The risk of cerebrovascular disease, hypertension, coronary heart disease and peripheral vascular disease is higher in meridian, blood vessels, and multiple systems. Related studies at home and abroad have confirmed that about 80% of patients with diabetic patients died of thrombotic disease, the anticoagulant and fibrinolytic activity of type.2 diabetic patients with thrombotic disease. Lowering, hypercoagulability, coagulation, fibrinolysis, blood in hypercoagulable state, and hypercoagulable state with complications, how to relieve the hypercoagulable state of type 2 diabetic patients by early intervention and effectively improve the blood coagulation function of diabetic patients has become a serious problem faced by clinical medical staff. Objective to investigate the effect of intensive insulin therapy on coagulation function in patients with type 2 diabetes (Type 2 diabetes mellitus, T2DM). Objects and methods were selected in 60 cases of type 2 diabetic patients admitted to our department of Endocrinology from September 2013 to 9 months of 2014. The diagnosis and classification of diabetes were in accordance with the WHO (WHO) standard in 1999. For the new diagnosis of type 2 diabetes, the patients were set up as the treatment group, and 60 healthy people who received physical examination in our hospital at the same time were used as the control group. The FBG, 2PBG, HbA1c, blood lipid, insulin and coagulation indexes were measured by fasting blood, and the time of prothrombin, the time of activation of blood coagulation enzyme and the international standardized ratio. Isisin was treated for 3 months, then exogenous insulin was discontinued, and blood coagulation index, HbA1c, FBG, 2PBG, and blood lipid were measured on empty stomach. The changes of insulin beta cell function (Homa beta) and insulin resistance index IR (HomaIR) were calculated, and the changes of the above indexes in the treatment group were compared before and after treatment, and the above indexes in the treatment group were compared with the control group. The general data of sex, age and body mass index (BMI) in the treatment group and the control group had no statistical difference (P0.05), which was comparable. The FBG, 2PBG, HbA1c, Cholesterol, TC, low density lipoprotein (Low-density lipoprotein, LDL), and triglyceride (Triglyceride, TG) in the pre treatment group were significantly higher than those in the control group. (P0.05), high density lipoprotein (High density lipoprotein, HDL) and Homa beta decreased, HomaIR increased, prothrombin time (Prothrombin time, PT), partial activated thromboplastin time (Activated partial) and international standardization ratio were significantly shortened, and thromboplastin time Romboplastin time, TT) did not change obviously. After treatment, the patients with FBG, 2PBG, HbA1c, TG were significantly decreased, HDL increased, Homa beta and HomaIR obviously improved, PT, APTT, and other coagulation indexes were significantly longer, compared with the group before treatment, but it was still higher than the control group. The blood coagulation indexes of omaIR, PT, APTT and INR were significantly shortened, and the differences were statistically significant (P0.05). Conclusion the patients with type 2 diabetes have high coagulation status, and the coagulation function can be effectively improved by intensive insulin therapy. The coagulation function of the patients after intensive insulin treatment is not restored to normal level, and may be related to blood glucose blood. The level of lipid is not fully restored to normal.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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