止血相关参数对2型糖尿病和糖尿病肾病预测的临床意义  

Clinical significance of hemostatic parameters in the prediction of type 2 diabetes mellitus and diabetic nephropathy

作　　者：钱科威[1] 顾晓琦 孙晓红[1] 钟梦丹 崔艳 李红[1] 戴强[1] 杨敏[2] QIAN Ke-wei;GU Xiao-qi;SUN Xiao-hong;ZHONG Meng-dan;CUI Yan;LI Hong;DAI Qiang;YANG Min(Department of Endocrinology,Zhangjiagang Traditional Chinese Medicine Hospital(Zhangjiagang Hospital,Nanjing University of Traditional Chinese Medicine),Zhangjiagang 215600,China)

机构地区：[1]江苏省张家港市中医医院(南京中医药大学附属张家港医院)内分泌科,张家港215600 [2]江苏省常州市第一人民医院肾内科,常州213003

出　　处：《临床肾脏病杂志》2020年第1期36-41,共6页Journal Of Clinical Nephrology

基　　金：江苏省卫生计生委2017年医学科研课题面上课题(H201702)

摘　　要：目的本研究旨在评估止血相关参数对2型糖尿病(type 2 diabetes mellitus,T2DM)和糖尿病肾病(diabetic nephropathy,DN)的预测价值。方法研究纳入96例T2DM患者分为两组,无并发症T2DM组(52例)和DN组(44例),同时纳入同期进行体检的50例性别、年龄匹配的健康人群作为对照组,测量各组基线实验室指标和止血相关参数,分析T2DM和DN的危险因素及其预测指标。结果无并发症的T2DM患者与对照组相比,活化部分促凝血酶原激酶时间(activated partial thromboplastin time,APTT)、血小板(platelets,PLT)和D-二聚体(D-Dimer,D-D)水平显著不同(P<0.01)。与没有并发症的T2DM患者相比,DN患者的纤维蛋白原(fibrinogen,FIB)、PLT和D-D增加(P<0.05)。APTT和PLT均为T2DM的独立危险因素(OR值分别为1.743、1.238,P<0.01),FIB和PLT是DN的独立危险因素(OR值分别为1.642、1.317,P<0.01)。APTT和PLT预测T2DM的ROC曲线下面积(area under curve,AUC)分别为0.601和0.642,且灵敏度较低。FIB取临界值3.15 g/L时预测DN的AUC为0.876,灵敏度(84%)和特异度(77%)较高,PLT取临界值245×109/L预测的DN的AUC为0.571,灵敏度为61%,特异度为89%。当联合FIB和PLT时,其预测DN能力增加(AUC:0.887,95%CI:0.841~0.937,灵敏度:91%,特异度:74%)。结论止血相关参数对T2DM的预测价值较低,而FIB是DN的独立危险因素,对DN有较高的预测价值。Objective This study was aimed at evaluating the predicting significance of hemostatic parameters for type 2 diabetes mellitus(T2DM)and diabetic nephropathy(DN).Methods A total of 96 patients with T2DM were divided into two groups,T2DM without complications(52 cases)and T2DM with nephropathy(44 cases);at the same time,50 cases of healthy control people admitted simultaneously with corresponding sex and age.Hematologic parameters before treatment were measured in 96 T2DM patients and 50 healthy controls,so as to evaluate the risk factors and their predictive ability.Results The T2DM patients without complications exhibited significantly different activated partial thromboplastin time(APTT),platelet(PLT),and D-dimer(D-D)levels,compared with the controls(P<0.01).Fibrinogen(FIB),PLT,and D-D increased in DN patients compared with those without complications(P<0.05).Both APTT and PLT were the independent risk factors for T2DM(OR:1.743 and 1.238,respectively,P<0.01),and FIB and PLT were the independent risk factors for DN(OR:1.642 and 1.317,respectively,P<0.01).The areas under ROC curve(AUC)of APTT and PLT were 0.601 and 0.642,respectively,with low sensitivity in predicting T2DM.AUC of FIB was 0.876 with high sensitivity(84%)and specificity(77%)for DN,and that of PLT was 0.571,with sensitivity of 61%and specificity of89%based on the cutoff values of 3.15 g/L and 245×109/L,respectively.When combining FIB and PLT,the predicting ability increased(AUC:0.887,95%CI:0.841~0.937,sensitivity:91%,specificity:74%).Conclusions Hemostatic parameters have a low predicting value for T2DM,whereas fibrinogen is the independent risk factor with high predicting power for DN in patients with type 2 diabetes mellitus.

关 键 词：2型糖尿病 糖尿病肾病 止血参数 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]