2型糖尿病肾病患者凝血四项与血脂检测的意义

目的：探讨2型糖尿病肾病（T2DN）患者不同时期凝血四项与血脂的改变及其临床意义。方法本研究选择健康对照组37例，2型糖尿病肾病（T2DN）组150例。根据24 h微量白蛋白（MAU）定量将T2DN患者分为正常蛋白尿组（n=70例，24 h MAU〈30 mg/24 h），微量白蛋白尿组（n=50例，24 h MAU 30~300 mg/24 h）、临床蛋白尿组（n=30例，24 h MAU〉300 mg/24 h）。比较各组的空腹血糖（FBG）、甘油三酯（TG）、同型半胱氨酸（HCY）、糖化血红蛋白（HbA1c）、凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、纤维蛋白原（FIB）水平以及凝血酶时间（TT）。除此之外，以尿总蛋白（MTP）为应变量，FBG、TG、HCY、HbA1c为自变量进行多元线性回归分析。结果（1）与健康对照组比较，其他三组的FBG、TG、FIB均明显增高（P〈0.01），TT明显延长（P〈0.01）；（2）与正常蛋白尿组、微量白蛋白尿组比较，临床蛋白尿组的FIB明显增高（P〈0.05），TT明显延长（P〈0.05）；（3）与正常蛋白尿组、微量白蛋白尿组比较，临床蛋白尿组HCY明显增高（P〈0.05）；与正常蛋白尿组比较，临床蛋白尿组HbA1c明显增高（P〈0.05）；（4）多元线性回归方程分析显示，对MTP的影响从大到小依次为HCY、FBG、TG、HbA1c。结论（1） T2DN患者较正常人群存在着血脂水平的异常及凝血功能的紊乱；（2）随着MAU的升高，HCY、HbA1C、FIB逐渐升高，TT逐渐延长；（3）HCY对MTP的影响最大，其次为FBG。

Significance of the detection of blood lipids and four coagulation tests in patients with type 2 diabetic nephropathy

Objective To explore the changes and clinical significance of blood lipids and four coagulation tests in patients with type 2 diabetic nephropathy. Methods 150 cases of type 2 diabetic nephropathy （T2DN） and 37 healthy people （control group） were selected in the study. According to MAU, the patients with Type 2 Diabetic Ne-phropathy were subdivided into three group：normal albuminura group （70 cases,24 h MAU〈30 mg/24 h）, microalbu-minura group （50 cases, 24 h MAU 30~300 mg/24 h） and clinical proteinuria group （30 cases, 24 h MAU〉300 mg/24 h）. Fasting blood glucose （FBG）, triglyceride （TG）, homocysteine （HCY）, glycosylated hemoglobin （HbA1c）, prothrom-bin time （PTc, activated partial thrombin time （APTT）, fibrinogen （FIB） and thrombin time （TT） were compared be-tween groups. In addition, multiple linear regression analysis was applied with MTP as a dependent variable and FBG, TG, HCY and HbA1c as independent variables. Results （1） Compared with healthy controls, FBG, TG and FIB in the other three groups significantly increased （P〈0.01）, and TT was extended obviously （P〈0.01）. （2） Compared with healthy control and microalbuminura groups,FIB in clinical proteinuria group significantly increased （P〈0.05） and TT extended significantly （P〈0.05）. （3） Compared with healthy controls and microalbuminura group, HCY in clinical pro-teinuria group significantly increased （P〈0.05）. Compared with healthy controls, HbA1c in clinical proteinuria group significantly increased （P〈0.05）. （4） The multivariate linear regression equation analysis demonstrated that HCY, FBG, TG and HbA1c were in descending order to impact MTP. Conclusion （1） There were abnormal blood lipid levels and blood coagulation function disorder in T2DN patients compared to healthy people. （2） With the increase of MAU, HCY, HbA1c and FIB gradually raised and TT gradually extended. （3） HCY impacted MTP mostly, followed by FBG.