急性冠脉综合征合并2型糖尿病患者血栓弹力图变化的研究  

Study on the changes of thromboelastography in patients with acute coronary syndrome and type 2 diabetesmellitus

作　　者：刘俊杰 夏勇 徐通达 LIU Junjie;XIA Yong;XU Tongda(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院心内科,江苏徐州221000

出　　处：《中国急救复苏与灾害医学杂志》2021年第9期1015-1019,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省科技厅重点研发计划(编号:BE2019639)。

摘　　要：目的研究合并2型糖尿病的急性冠状动脉(冠脉)综合征患者凝血状态。方法回顾性分析2019年9月-2020年9月来自徐州医科大学附属医院诊断急性冠脉综合征的525名患者,根据有无合并2型糖尿病及急性冠脉综合征分型,分为2型糖尿病组(n=141),其中ST段抬高型心肌梗死35名患者,非ST段抬高型急性冠脉综合征106名患者;非2型糖尿病组(n=384),其中ST段抬高型心肌梗死112名患者,非ST段抬高型急性冠脉综合征272名患者。入院后收集患者临床资料及血栓弹力图参数,再通过Person相关统计学方法,依据血栓弹力图分析急性冠脉综合征患者的凝血状态与传统凝血指标之间的相关性;单因素分析其临床特点,并通过多因素Logistic回归分析合并2型糖尿病的急性冠脉综合征患者临床危险因素。结果①与非2型糖尿病组比较,2型糖尿病组患者收缩压(systolic blood pressure,SBP)、空腹血糖(fa sting blood glucose,GLU)、氨基末端脑钠肽前体(N-terminal-proBNP,NT-proBNP)及糖化血糖蛋白(hemoglobin A1c,HbA1c)等显著增高(P<0.05),血红蛋白(hemoglobin,Hb)、谷草转氨酶(aspartate aminotransferase,AST)等水平下降(P<0.05);②血栓弹力图参数比较与其他三组相比较,合并2型糖尿病的急性冠脉综合征患者血液状态更趋于高凝状态;③反应时间(re⁃action time,R)与凝血酶时间(thrombin time,TT)呈负相关,Angle与TT呈正相关,最大振幅(maximum ampli⁃tude,MA)与纤维蛋白原(fibrinogen,FIB)呈正相关,剪切弹性模量(shear elastic modulus,G)与活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和FIB呈正相关;④各组多因素Logistic回归分析结果以2型糖尿病为因变量,在ST段抬高型心肌梗死患者中,与收缩压、糖化血红蛋白、R、综合凝血指数(coagulationin⁃dex,CI)、MA、G具有相关性;而在非ST段抬高型急性冠脉综合征患者中,与空腹血糖、血红蛋白、糖化血红蛋白、R、凝固时间(Objective To study the coagulation status patients with acute coronary(coronary)syndrome with type 2 dia‐betes.Methods A retrospective analysis of 525 patients diagnosed with acute coronary syndromes from the Affiliated Hos‐pital of Xuzhou Medical University from September 2019 to September 2020 were divided into categories according to the presence or absence of type 2 diabetes and acute coronary syndromes.Type 2 diabetes group(n=141),including 35 pa‐tients with ST elevation myocardial infarction and 106 patients with non-ST elevation acute coronary syndrome;non-type 2 diabetes group(n=384),of which 112 patients were in the nT2DM-STEMI group and 272 patients were in the nT2DM NSTE-ACS group.After admission,collect the patient's clinical data and thromboelastography parameters,and then ana‐lyze the correlation between the coagulation status of patients with acute coronary syndromes and traditional coagulation indicators based on the Person correlation statistics method;single-factor analysis of its clinical characteristics,And ana‐lyzed the clinical risk factors of acute coronary syndrome patients with type 2 diabetes by multivariate Logistic regression.Results①Compared with the non-type 2 diabetes group,the type 2 diabetes group had systolic blood pressure(SBP),fast‐ing blood glucose(GLU),and N-terminal-proBNP(NT-proBNP)and HbA1c were significantly increased(P<0.05),and the levels of hemoglobin(Hb)and aspartate aminotransferase(AST)decreased(P<0.05);②Thromboelasticity compared with the other three groups,the blood status of patients with acute coronary syndrome with type 2 diabetes tends to be hy‐percoagulable;③The correlation between the thromboelastogram and traditional coagulation indicators.Reaction time(R)It is negatively correlated with thrombin time(TT),Angle and TT are positively correlated,maximum amplitude(MA)is positively correlated with Fibrinogen(FIB),and shear elastic modulus(shear elastic modulus,G)is positively correlat‐ed with activated partial thromboplastin time(APTT)and

关 键 词：急性冠脉综合征 2型糖尿病 血栓弹力图 传统凝血指标 

分 类 号：R541.4[医药卫生—心血管疾病]