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目的:通过检测血浆可溶性血栓调节蛋白(STM)和D-二聚体(D-dimer)水平,分析糖尿病患者脆性血液的程度,探讨脆性血液的严重程度与糖尿病患者下肢动脉粥样硬化的关系,并寻找便宜、相对无创、实用且对已明确危险因素有额外增加预测价值的评价指标或方法。方法:选取疑为糖尿病下肢动脉粥样硬化患者,行多普勒超声检查的糖尿病下肢动脉硬化患者及体检健康者为研究对象,共60例,分糖尿病无下肢动脉粥样硬化病变组(A组)12例,糖尿病有下肢动脉粥样硬化病变组(B组)30例,正常对照组(C组)18例。记录所有研究对象的临床资料和生化指标以及下肢动脉硬化程度;用ELISA方法检测血浆STM和D-dimer水平,采用SPSS13.0统计软件进行统计学分析。结果:①糖尿病无下肢动脉病变组(A组)、糖尿病有下肢动脉病变组(B组)与正常对照组(C组)比较,吸烟指数、SBP、DBP、TC、TG、FBG、STM、D-dimer均有统计学差异(P<0.05),其中STM、D-dimer水平明显升高;B组SBP、STM和D-dimer水平明显高于A组,差异均有统计学意义(P<0.05),其余指标无显著性差异;②Spearman相关分析示:STM与SBP有显著性相关关系,和D-dimer有显著性相关趋势,D-dimer与年龄、FBG有显著性相关关系,吸烟指数、FBG、STM和D-dimer均与下肢动脉病变程度有显著性相关关系;③有序结果的累积比数Logistic回归结果:D-dimer和STM每增加一个等级时,下肢动脉硬化程度增加一个等级的可能性分别增加1.43倍和0.88倍。结论:血液的脆性增加可能是糖尿病合并周围血管病变的重要因素之一,糖尿病脆性血液与其并发下肢动脉粥样硬化的关系密切。
OBJECTIVE: To analyze the degree of fragile blood in diabetic patients by detecting the levels of plasma soluble thrombomodulin (STM) and D-dimer, and to explore the relationship between the severity of blood fragility and atherosclerosis in lower extremities of diabetic patients. And find cheaper, relatively noninvasive, practical and have an additional increase in the risk factors have an estimated value of the evaluation indicators or methods. Methods: A total of 60 patients with atherosclerotic diabetic lower extremity arterial atherosclerosis, diabetic lower extremity arteriosclerosis undergoing Doppler echocardiography and healthy subjects were enrolled in this study. ), 12 cases of diabetic lower extremity atherosclerosis lesions group (B group) 30 cases, normal control group (C group) 18 cases. All subjects were recorded clinical data and biochemical indicators and lower extremity arteriosclerosis; ELISA method was used to detect plasma levels of STM and D-dimer, using SPSS13.0 statistical software for statistical analysis. RESULTS: There was no significant difference in smoking index, SBP, DBP, TC, TG, FBG, STM, D between group A and group C with lower extremity arterial disease (group A) (P <0.05), and the levels of STM and D-dimer were significantly increased in group B. The levels of SBP, STM and D-dimer in group B were significantly higher than those in group A (P <0.05) ), There was no significant difference between the other indexes. (2) Spearman correlation analysis showed that there was a significant correlation between STM and SBP, D-dimer and D-dimer had significant correlation with age and FBG. Smoking index, FBG , STM and D-dimer were significantly correlated with the degree of arterial disease in the lower extremities. (3) Logistic regression results showed that there was a significant increase in the degree of atherosclerosis in lower extremity when D-dimer and STM were increased by one level Sex increased 1.43 times and 0.88 times respectively. Conclusion: Increased blood fragility may be one of the most important factors in the pathogenesis of diabetes mellitus complicated with peripheral vascular disease. Diabetes crisp blood has a close relationship with arterial atherosclerosis.