糖尿病足坏疽患者血脂、凝血功能与踝肱指数的相关性研究  

Correlation between blood lipids,blood coagulation and ankle brachial index in patients with diabetic foot gangrene

作　　者：王伟灵[1] 赵延荣[1] 周丽霞[1] 郑培莉 顾慧群 王淑芬[1] 

机构地区：[1]上海市中西医结合医院检验科,上海200082

出　　处：《检验医学》2010年第11期897-900,共4页Laboratory Medicine

基　　金：上海市虹口区卫生局重点科研课题基金资助项目(虹卫0802-05)

摘　　要：目的探讨糖尿病足坏疽患者血脂、凝血功能的变化以及与踝肱指数(ABI)的相关性。方法采用多普勒血流探测仪分别测定137例糖尿病足坏疽患者(DF组)和58例非下肢病变的糖尿病患者(DM组)的ABI,同时采集空腹静脉血检测血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apo A1)、载脂蛋白B(apo B)、脂蛋白(a)[Lp(a)]、血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)。结果 DF组和DM组间年龄、性别、FPG、HbA1c差异均无统计学意义(P>0.05)。DF组Lp(a)、PLT、PT、APTT、FIB均高于DM组(P<0.05、P<0.01),TG、apo A1和ABI低于DM组(P<0.05、P<0.01)。ABI与年龄、HbA1c、PT及Lp(a)呈高度相关(r分别为-0.499、0.187、-0.212、-0.207,P<0.01、P<0.05)。年龄、Lp(a)为ABI异常的独立风险因素[比值比(OR)分别为1.10、3.66,P<0.01、P<0.05];而ABI、Lp(a)和apo A1异常是糖尿病足发生的独立风险因素(OR分别为34.36、4.87、3.24,P<0.01、P<0.05)。ABI与Lp(a)联合诊断DF的受试者工作特征(ROC)曲线下面积(AUC)为0.790。结论与DM患者相比,DF患者存在更为明显的下肢动脉硬化和血栓形成趋势;年龄、HbA1c、PT、Lp(a)与ABI相关;联合检测ABI和Lp(a)可能有助于提高DF患者的诊断效率。Objective To investigate the correlations of the change of blood lipids and blood coagulation with ankle brachial index（ABI） in patients with diabetic foot gangrene.Methods ABI was measured by Doppler flow detector in 137 patients with diabetic foot（DF group） and 58 diabetes patients without lower extremity lesion（DM group）.Fasting blood glucose（FPG）,glycosylated hemoglobin（HbA1c）,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,apolipoprotein A1（apo A1）,apolipoprotein B（apo B）,lipoprotein（a） ,platelet（PLT） count,prothrombin time（PT）,activated partial thromboplastin time（APTT）,fibrinogen（FIB） and thrombin time（TT） were measured by routine methods in the laboratory.Results Between DF group and DM group,age,sex,FPG and HbA1c had no significant difference（P 0.05）.The levels of Lp（a）,PLT,PT,APTT and FIB in the DF group were significantly higher than those in the DM group（P0.05,P0.01）.However,the levels of TG,apo A1 and ABI in the DF group were significantly lower than those in the DM group（P0.05）.ABI was significantly correlated with age（r =-0.499,P0.01）,HbA1c（r = 0.187,P0.05）,PT（r =-0.212,P0.05） and Lp（a）（r =-0.207,P0.05）.Age [odds ratio（OR） = 1.10,P0.01] and Lp（a）（OR = 3.66,P0.05） were independent risk factors for abnormal ABI,and ABI（OR = 34.36,P0.01）,Lp（a）（OR = 4.87,P0.01）,and apo A1（OR = 3.24,P0.05） were independent risk factors for DF disorders.When the combined detection of ABI and Lp（a） was used for DF diagnosis,the area under the receiver operating characteristic（ROC） curve（AUC） was 0.790.Conclusions Compared to patients with DM,DF patients have more obvious trends of lower extremity atherosclerosis and thrombosis.The age,HbA1c,PT and Lp（a） are related to ABI.The combined detection of ABI and Lp（a） may improve the diagnostic efficiency for DF patients.

关 键 词：血脂 凝血功能 踝肱指数 糖尿病足 

分 类 号：R446.1[医药卫生—诊断学]