老年2型糖尿病和空腹血糖受损患者血小板功能与胰岛素抵抗相关性分析

目的 探讨60岁以上老年2型糖尿病（T2DM）和空腹血糖受损（IFG）患者血小板功能与胰岛素抵抗（IR）的相关性.方法 入选2型糖尿病组患者769例,IFG组患者856例和正常组（NGT） 764例,比较各组间血小板参数差异.采用稳态模型评估胰岛素抵抗（HOMA-IR）,用Spearman相关分析和Stepwise多元逐步回归分析评价血小板参数对胰岛素抵抗的影响.结果 2型糖尿病组血小板平均体积（MCV）为（11.0±1.1）、血小板分布宽度（PDW）（14.6±2.5）均显著高于对照组（MCV：10.8±1.0;PDW：14.0±2.2）和IFG组（MCV：10.9±1.0;PDW：14.2±2.3）（P＜0.01）;所有入组患者HOMA-IR四分位分组,PDW及MCV随着HOMA-IR的水平升高而逐步升高;MCV及PDW四分位组,第二分组（Q2）的HOMA-IR水平最低;Spearman相关分析显示,血小板计数（PLT）（r=0.04）、PDW（r=0.073）、MCV（r =0.061）与HOAM-IR呈正相关;Stepwise多元逐步分析显示,PDW与HOMA-IR独立相关.结论 老年2型糖尿病患者血小板体积增大,体积变异度增大,胰岛素抵抗与血小板分布宽度独立相关.

The relationship between platelet activation and insulin resistance in elderly patients of type 2 diabetes or impaired fasting glucose

Objective To investigate the correlation between platelet function and insulin resist- ance（IR） in patients with type 2 diabetes （T2DM） or impaired fasting glucose （IFG） aged 60 or elder. Methods 769 cases of T2DM,856 cases of IFG group and 764 cases of normal group（NGT） were en- rolled in this study. Platelet parameters of each group were determined. Using the homeostasis model eval- uate insulin resistance. Correlation between platelet parameters and insulin resistance was performed using Spearman＇ s rank correlation and stepwise multiple regression analysis. Results The level of MCV （ 11.0 ＋_ 1.1 ）, PDW（ 14.6 -＋ 2.5 ） in T2DM group were significantly higher than those in control group（ MCV： 10.8 ＋ 1.0 ; PDW ： 14.0 ＋ 2.2） （ P 〈 0.01 ） ; In all participants, HOMA-IR was divided into four quartile, with the increase of HOMA-IR, the level of PDW and MCV gradually increased ; on the other hand, MCV and PDW was divided into four groups,the second group（Q2） of MCV and PDW had the lowest level of HOMA-IR. Spearman＇ s rank correlation showed that PLT （ r = 0.04 ） , PDW （ r = 0. 073 ）, MCV （ r -- O. 061 ） were significant positive correlation with HOMA-IR;Multiple stepwise analysis showed PDW inde- pendently associated with HOMA-IR. Conclusion Platelet volume in elderly patients with T2DM increa- ses and the volume variability of platelet increases. Insulin resistance and platelet distribution width inde- pendently associated.