血浆纤维蛋白原及血小板计数与糖尿病足及其预后的关系  

Roles of Fibrinogen and Platelet in Pathogenesis and Prognosis of Diabetic Foot

作　　者：周兴建[1] 王大华 杨国铭 李芳 刘勇 朱丹 杨文健 李颖菊 周珍 龚宇 

机构地区：[1]湖北医药学院附属襄阳医院内分泌科 [2]襄阳市中医院病案室,湖北襄阳441000

出　　处：《湖北医药学院学报》2013年第6期492-494,506,共4页Journal of Hubei University of Medicine

基　　金：湖北省襄阳市科技攻关指导性项目(2009026)

摘　　要：目的:探讨血浆纤维蛋白原(Fibrinogen,FIB)、血小板计数(Platelet,PLT)对糖尿病足(Diabetic foot,DF)及其预后的影响。方法:选取DF患者161例,按Wagner分级,DF(1~2级)组99例,DF(3~5级)组62例;住院期间截肢22例;2型糖尿病无足病组(T2DM组)42例;健康对照组(NC组)20例。检测所有患者血浆FIB水平,PLT、FPG、HbA1c、TC、TG、HDL-C、LDL-C及其他临床指标。采用Logistic回归分析筛选糖尿病足截肢的危险因素。结果:与NC组比较,T2DM组FIB、TC、LDL-C、FPG、TG、HbAlc水平升高(P均<0.05);与DF(1~2级)比较,DF(3~5级)组TC、HDL-C、TG、Alb水平降低(P均<0.05),FIB、FPG水平升高(P均<0.01)。与未截肢组比较,截肢组FIB、FPG、HbAlc升高(P均<0.05),TG、LDL-C、HDL-C、Alb降低(P均<0.01)。PLT在各组之间差异无统计学意义(P>0.05)。多因素Logistic回归分析显示:FIB(OR=4.572,P=0.012)、低蛋白血症(OR=4.615,P=0.008)是DF截肢的独立危险因素。结论:FIB水平升高增加了糖尿病患者DF的发生和截肢的风险。血小板计数与DF的发生和截肢无明显关系。Objective To explore the roles of fibrinogen and platelet in the pathogenesis and prognosis of patients with diabetic foot. Methods According to the classification of Wagner,161 patients with diabetic foot were divided into grade 1 ~ 2 group( n = 99) and grade 3 ~ 5 group( n = 62). In addition,22 patients amputated during hospital stay,42 cases of type 2 diabetic patients without diabetic foot( T2DM group),20 cases of healthy control were enrolled in this study. The plasma levels of fibrinogen,platelet count,FPG,the blood levels of HbA1c,TC,TG,HDL-C,LDL-C were detected in all subjects. The high risk factors of amputation in patients with dabetic foot were analyzed with Logistic regression analysis based on the above detective results. Results Compared with healthy control,the levels of FIB,TC,LDL-C,FPG,TG,HbA1c were all significantly increased in patients with T2DM( all P < 0. 05). Compared with grade 1 ~ 2 group,the levels of TC,HDL-C,TG, Alb were all significantly decreased in grade 3 ~ 5 group( all P < 0. 05). Compared with T2DM patients without amputation, the levels of FIB,FPG,HbA1c were all significantly increased,but the levels of TG,LDL-C,HDL-C,Alb were all significantly decreased in amputated patients( all P < 0. 05). The results of blood platelet count had no significant difference among all groups( P > 0. 05). The results of multivariate Logistic regression analysis demonstrated that fibrinogen( OR = 4. 572,P = 0. 012) and hypoalbuminemia( OR = 4. 615,P = 0. 008) were the independent risk factors of amputation in patients with diabetic foot. Conclusion The upregulation of plasma fibrinogen increases the risk of diabetic foot and even amputation in patients with T2DM. Blood platelet has no relation with the incidence of diabetic foot and amputation.

关 键 词：纤维蛋白原 血小板计数 糖尿病足 截肢 

分 类 号：R587.2[医药卫生—内分泌]