2型糖尿病合并甲状腺功能异常患者凝血功能的回顾性研究  

Analysis of coagulation function in type 2 diabetes mellitus patients complicated with thyroid dysfunction

作　　者：周罗成[1] 王尧[1] 王晓[1] 王海嵘[1] 

机构地区：[1]上海交通大学医学院附属新华医院急诊科,上海200092

出　　处：《内科理论与实践》2017年第4期283-287,共5页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨2型糖尿病(T2DM)合并甲状腺功能异常与患者凝血功能的关系。方法:收集215例T2MD合并甲状腺功能异常患者[其中89例甲状腺功能亢进(甲亢)、126例甲状腺功能减退(甲减)]以及225例单纯T2MD患者的甲状腺功能和凝血功能资料,分析甲状腺功能异常与T2DM患者凝血功能的关系,并且就空腹血糖、甲状腺功能与出凝血相关指标之间的关联性进行分析。结果:T2DM合并甲亢组的凝血酶原时间(PT)和凝血酶时间(TT)与单纯T2DM组相比显著缩短(P<0.05),而活化部分凝血活酶时间(APTT)在2组之间的差异无统计学意义(P>0.05),合并甲亢组的血纤蛋白原(FIB)水平显著升高(P<0.05)。与单纯T2DM组相比,T2DM合并甲减患者除TT延长(P<0.05)外,其他指标差异均无统计学意义(均P>0.05)。空腹血糖与凝血功能PT之间呈负相关(r=-0.409,P<0.05),与FIB呈正相关(r=0.356,P<0.05);而促甲状腺素(TSH)与PT呈正相关(r=0.334,P<0.05),与FIB呈负相关(r=-0.465,P<0.05)。结论:甲状腺功能异常对T2MD患者凝血功能有一定的影响,合并甲亢可以加重T2MD的高凝状态,合并甲减则相对纤溶亢进。同时血糖不控制可能造成高凝事件的发生。Objective To investigate the effect of type 2 diabetes mellitus （T2DM） complicated with thyroid dysfunc- tion on coagulation function. Methods Two hundred and fifteen patients with T2DM complicated with thyroid dysfunction （89 cases with hyperthyroidism and 126 with hypothyroidism） and 225 T2DM patients with normal thyroid function were enrolled. The coagulation function of these patients were analyzed, and correlation analysis of fasting blood glucose, thyroid related parameters and coagulation related parameters were conducted. Results Compared with T2DM patient with normal thyroid function, prothrombin time（PT） and thrombin time（TT） in T2DM patients with hyperthyroidism were significantly de- creased（P〈0.05）, no significant difference in activated partial thromboplastin time（APTT） was found （P〈0.05）, and fibrinogem （FIB） level was significantly elevated （P〈0.05）. T2DM patients complicated with hypothyroidism had significantly higher TT （P〈0.05）, and no significant differences were found in other indexes （P〉0.05）. There was a negative correlation between PT and fasting blood glucose （r=-0.409, P〈0.05） and a positive correlation between FIB and fasting blood glucose （r=0.356, P〈0.05）. Thyroid stimulating hormone （TSH） was positively correlated with PT （r=0.334, P〈0.05）, and negatively correlated with FIB （r=-0.465, P〈0.05）. Conclusions Coagulation function of T2DM patients was influenced by thyroid dysfunction, hyperthyroidism could aggravate hypercoagulable state of T2DM patients, while the effect of hypothyroidism on coagulation function was to increase relatively the systemic fibrinolysis activity. Meanwhile, non-controlling of blood glucose might induce the occurrence of hypercoagulability.

关 键 词：2型糖尿病 甲状腺功能亢进 甲状腺功能减退 凝血功能 

分 类 号：R581[医药卫生—内分泌] R587.1[医药卫生—内科学]