2型糖尿病合并下肢骨折患者凝血分子标志物的变化及其与血栓形成的关系

目的 探讨骨折对2型糖尿病患者凝血活性的影响及其与血栓性疾病发生的关系.方法 测定2型糖尿病合并下肢骨折患者(糖尿病骨折组,n=90)、2型糖尿病患者(糖尿病组,n=90)及性别、年龄、体质量指数(BMI)均有可比性的健康人群(正常对照组,n=90)的血浆纤维蛋白原(Fib)、D-二聚体(D-dimer)、血管性血友病因子(vWF)、血小板膜颗粒糖蛋白140(GMP-140)、凝血酶原片段1+2(F1+2)、凝血酶激活的纤溶抑制物(TAFI)及组织因子途径抑制物(TFPI)等含量或活性水平,并进行组间比较.结果 糖尿病骨折组Fib、D-dimer、vWF、GMP-140、F1+2和TAFI的测定值分别为(5.3±1.4)g/L、(1 350.1±88.3)ng/mL、(161.9±6.6)IU/dL、(21.8±2.5)μg/L、(1.6±0.5)nmol/L、(30.5±3.8)μg/mL;糖尿病组的相应测定值分别为(4.1±1.2)g/L、(880.5±35.6)ng/mL、(123.6±5.5)IU/dL、(18.9±2.3)μg/L、(1.3±0.3)nmol/L、(28.3±2.9)μg/mL,正常对照组的相应测定值分别为(2.5±0.6)g/L、(145.7±22.5)ng/mL、(96.8±4.5)IU/dL、(13.8±2.1)μg/L、(0.8±0.2)nmol/L、(26.4±2.5)μg/mL,糖尿病骨折组和糖尿病组的测定值均较正常对照组显著增高(F=141.70、10 396.17、3 072.95、277.67、116.05、39.06,P<0.001),且糖尿病骨折组较糖尿病组显著增高(18.5±2.7);糖尿病骨折组和糖尿病组的血浆TFPI活性均低于正常对照组(16.2±1.3,17.3±2.1,18.5±2.7,U/mL),且糖尿病骨折组较糖尿病组更低,差异有统计学意义(F=26.68,P<0.001).结论 骨折可导致糖尿病患者的凝血活性增强,高凝状态加剧,进而易发生血栓栓塞性疾病.

Changes of thrombosis molecular markers and their clinical values in type 2 diabetic patients with low extremity fractures

Objective To explore the effects of fracture on the activity of blood coagulation in patients with type 2 diabetes mellitus and the relationship between fracture and thrombotic diseases. Methods A total of 90 patients with type 2 diabetes mellitus and lower limb fracture (diabetic and fracture group), 90 patients with type 2 diabetes (diabeticgroup) and 90 healthy controls with comparable of sex, age and body mass index (control group) were recruited. The contents or activity of plasma fibrinogen (Fib), D-dimer (D-dimer), von willebrand factor (vWF), platelet membrane glycoprotein 140 (GMP-140), prothrombin fragment 1+2 (F1+2), thrombin activation of fibrinolysis inhibitor(TAFI) and tissue factor pathway inhibitor (TFPI), were compared. Results In the diabetic and facture group, the values of Fib, D-dimer, vWF, GMP-140, F1+2 and TAFI were (5.3±1.4) g/L, (1 350.1±88.3) ng/mL, (161.9±6.6) IU/dL, (21.8±2.5) μg/L, (1.6±0.5) nmol/L and (30.5±3.8) μg/mL, respectively. In the diabetic group, the values were (4.1±1.2) g/L, (880.5±35.6) ng/mL, (123.6±5.5) IU/dL, (18.9±2.3) μg/L, (1.3±0.3) nmol/L, (28.3±2.9) μg/mL, respectively. In the control group, the values were (2.5±0.6) g/L, (145.7±22.5) ng/mL, (96.8±4.5) IU/dL, (13.8±2.1) μg/L, (0.8±0.2) nmol/L, (26.4±2.5) μg/mL, respectively. The values of the former two groups were significantly higher than those of the control group, and the values of the diabetic and fracture group were higher compared to those of the diabetic group (F=141.70, 10 396.17, 3 072.95, 277.67, 116.05, 277.67, P<0.001). The plasma TFPI activity of the former two groups was lower than that of the control group (16.2±1.3, 17.3±2.1, 18.5±2.7, U/mL). And it was the lowest in the diabetic and fracture group (F=26.68, P<0.001). Conclusion Fractures can lead to blood clotting activity and high coagulation state in diabetic patients, thus such patients are prone to thromboembolic disorders.