糖尿病患者与空腹血糖水平正常患者TKA术后早期凝血状态变化趋势及临床意义
发布时间：2018-11-23 09:09
【摘要】：目的观察并比较糖尿病合并膝骨关节炎病人及空腹血糖水平正常病人在初次行单侧人工膝关节表面置换术后血清中凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、以及血小板计数(PLT)等的变化趋势及其临床意义。方法研究对象选取2014年12月至2016年12月在广州市第一人民医院诊断为骨性关节炎,并初次行单侧TKA手术的所有患者,入院时检测空腹血糖水平,根据空腹血糖水平及病史情况,将患者分为两组:糖尿病患者组及空腹血糖正常组(正常人组)。糖尿病组入组患者总数为30例,年龄范围在60-85岁之间,其中女性25例,男性5例;同一时期行初次TKA手术,无合并糖尿病的患者中选取与糖尿病组患者年龄、性别相对应或相符的30例患者作为正常人组,年龄范围在60-85岁之间,其中女性26例,男性4例。两组中所有观察对象除糖尿病组患者行控制血糖水平治疗等措施以外,于围手术期给予相同的临床干预、治疗。两组分别于术前、术后第1天、第3天,第7天清晨空腹采集肘前静脉血液标本,检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、以及血小板计数(PLT)等指标的变化。并通过对其变化趋势的分析,反映出其所表达的临床意义等情况。结果1.两组患者术后血液中FIB含量变化的趋势均为术后第1天开始升高,在术后第3天时达到峰值(糖尿病组=5.25g/L,正常人组=4.44g/L),虽然术后第7天较术后第3天有所下降,但较术前水平仍有上升,而且糖尿病组患者血液中FIB指标在术后各个时间点较正常人组都偏高,有统计学差异。2.两组患者血液中PLT计数的变化趋势基本一致,术后第1天较术前有明显下降,术后第3天下降到最低值(糖尿病组=203.60*109/L,正常人组209.80*109/L),到术后第7天时两组患者血液中的血小板水平恢复到术前水平。而两组患者在各时间点上的PLT计数没有统计学差异。3.两组患者的TT,APTT,PT值进行统计学分析比较,两组患者的这三组数据无论术前还是术后不同的时间点比较,均没有统计学差异。而这三组数据在各个组内不同时间点比较,除糖尿病组术前与术后第1天的TT值,APTT值有统计学差异外,其余的组内比较均无统计学意义。此三组指标术后无明显变化趋势,均在正常范围内波动。结论1.初次单侧TKA术后,膝关节骨关节炎伴糖尿病患者血液的高凝状态较空腹血糖正常的患者更为严重。2.膝关节骨关节炎患者初次单侧TKA术后FIB指标呈先升后降的变化趋势,术后监测FIB指标的变化有利于对评估膝关节骨关节炎患者TKA术后的凝血状态。
[Abstract]:Objective to observe and compare the serum prothrombin time (PT),) activation partial thromboplastin time (APTT),) in patients with diabetes mellitus complicated with knee osteoarthritis and normal fasting blood glucose level after the first unilateral artificial knee arthroplasty. Changes of thrombin time (TT), fibrinogen (FIB), and platelet count (PLT) and its clinical significance. Methods all the patients who were diagnosed as osteoarthritis from December 2014 to December 2016 in Guangzhou first people's Hospital and underwent unilateral TKA for the first time were selected and the fasting blood glucose level was measured on admission, according to the fasting blood glucose level and the history of the disease. The patients were divided into two groups: diabetic group and normal fasting blood glucose group (normal group). The total number of patients in the diabetes group was 30. The age range was between 60 and 85 years old. 25 cases were female and 5 cases were male. In the same period of initial TKA operation, 30 patients with diabetes mellitus (age, sex) were selected as normal subjects. The age ranges from 60 to 85 years old, including 26 women and 4 men. All the subjects in the two groups were given the same clinical intervention and treatment during perioperative period except diabetes patients. The blood samples of anterior elbow vein were collected before operation, 1 day, 3 days and 7 days after operation, respectively. The prothrombin time (PT),) and partial thromboplastin time (APTT),) were detected in the two groups. The thrombin time (TT),) was measured by partial thromboplastin time (APTT),). Changes of fibrinogen (FIB), and platelet count (PLT). And through the analysis of its changing trend, it reflects the clinical significance of its expression and so on. Result 1. The change trend of blood FIB content in both groups was beginning to increase on the first day after operation and reached its peak on the third day after operation (diabetes group = 5.25g / L, normal person group = 4.44g/L). Although on the 7th day after operation compared with the third day after operation, the level of blood FIB in the diabetic group was still higher than that in the normal group, and there was statistical difference between the diabetic group and the normal group at each time point. 2. The change trend of PLT in the blood of the two groups was basically the same. On the first day after operation, it was significantly lower than that before operation, and on the third day after operation, it decreased to the lowest value (diabetes group = 203.60 / 109 / L, normal group 209.80 / 109 / L). By the 7th day after operation, the platelet levels in the blood of the two groups returned to the preoperative level. There was no significant difference in PLT counts between the two groups at all time points. The TT,APTT,PT values of the two groups were statistically analyzed and compared. There was no statistical difference in the data of the three groups before and after operation. The data of the three groups were compared at different time points in each group, except for the TT value and APTT value of the diabetic group before and after the first day, there was no statistical significance in the other groups. There was no obvious change trend in these three groups after operation, and all of them fluctuated within normal range. Conclusion 1. After primary unilateral TKA, hypercoagulability in knee osteoarthritis with diabetes was more severe than that in patients with normal fasting blood glucose. 2. 2. The FIB index of knee osteoarthritis patients increased first and then decreased after primary unilateral TKA. Monitoring the changes of FIB index after operation was helpful to evaluate the coagulation status of TKA patients with knee osteoarthritis.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1
[Abstract]:Objective to observe and compare the serum prothrombin time (PT),) activation partial thromboplastin time (APTT),) in patients with diabetes mellitus complicated with knee osteoarthritis and normal fasting blood glucose level after the first unilateral artificial knee arthroplasty. Changes of thrombin time (TT), fibrinogen (FIB), and platelet count (PLT) and its clinical significance. Methods all the patients who were diagnosed as osteoarthritis from December 2014 to December 2016 in Guangzhou first people's Hospital and underwent unilateral TKA for the first time were selected and the fasting blood glucose level was measured on admission, according to the fasting blood glucose level and the history of the disease. The patients were divided into two groups: diabetic group and normal fasting blood glucose group (normal group). The total number of patients in the diabetes group was 30. The age range was between 60 and 85 years old. 25 cases were female and 5 cases were male. In the same period of initial TKA operation, 30 patients with diabetes mellitus (age, sex) were selected as normal subjects. The age ranges from 60 to 85 years old, including 26 women and 4 men. All the subjects in the two groups were given the same clinical intervention and treatment during perioperative period except diabetes patients. The blood samples of anterior elbow vein were collected before operation, 1 day, 3 days and 7 days after operation, respectively. The prothrombin time (PT),) and partial thromboplastin time (APTT),) were detected in the two groups. The thrombin time (TT),) was measured by partial thromboplastin time (APTT),). Changes of fibrinogen (FIB), and platelet count (PLT). And through the analysis of its changing trend, it reflects the clinical significance of its expression and so on. Result 1. The change trend of blood FIB content in both groups was beginning to increase on the first day after operation and reached its peak on the third day after operation (diabetes group = 5.25g / L, normal person group = 4.44g/L). Although on the 7th day after operation compared with the third day after operation, the level of blood FIB in the diabetic group was still higher than that in the normal group, and there was statistical difference between the diabetic group and the normal group at each time point. 2. The change trend of PLT in the blood of the two groups was basically the same. On the first day after operation, it was significantly lower than that before operation, and on the third day after operation, it decreased to the lowest value (diabetes group = 203.60 / 109 / L, normal group 209.80 / 109 / L). By the 7th day after operation, the platelet levels in the blood of the two groups returned to the preoperative level. There was no significant difference in PLT counts between the two groups at all time points. The TT,APTT,PT values of the two groups were statistically analyzed and compared. There was no statistical difference in the data of the three groups before and after operation. The data of the three groups were compared at different time points in each group, except for the TT value and APTT value of the diabetic group before and after the first day, there was no statistical significance in the other groups. There was no obvious change trend in these three groups after operation, and all of them fluctuated within normal range. Conclusion 1. After primary unilateral TKA, hypercoagulability in knee osteoarthritis with diabetes was more severe than that in patients with normal fasting blood glucose. 2. 2. The FIB index of knee osteoarthritis patients increased first and then decreased after primary unilateral TKA. Monitoring the changes of FIB index after operation was helpful to evaluate the coagulation status of TKA patients with knee osteoarthritis.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1
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