本文選題：高血壓 + 2型糖尿病�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:原發(fā)性高血壓合并2型糖尿病(Type 2 diabetes mellitus)比例較高,高血壓和糖尿病都可引起機(jī)體多處靶器官損害,尤其是增加發(fā)生心腦血管血栓事件的風(fēng)險(xiǎn)。血小板異常、凝血、纖溶系統(tǒng)改變均可導(dǎo)致患者形成血栓前狀態(tài),并進(jìn)而增加發(fā)生心腦血管血栓事件的風(fēng)險(xiǎn)。本研究即探討原發(fā)性高血壓及高血壓合并2型糖尿病糖患者血小板參數(shù)、凝血指標(biāo)水平的關(guān)系及臨床意義,同時(shí)檢測(cè)AT-Ⅲ、D-D及VWF水平探討血管內(nèi)皮功能損傷與凝血的關(guān)系。方法:選擇2016年1月到2016年10月在任丘市華北石油管理局總醫(yī)院心內(nèi)一科收治的高血壓合并T2DM(Type 2 diabetes mellitus 2型糖尿病)患者(高血壓T2DM組,n=50)和不伴糖尿病的原發(fā)性高血壓患者(高血壓組,n=50)。另選取同期進(jìn)行健康體檢的25例作為對(duì)照組。采用全自動(dòng)生化分析儀檢測(cè)血糖血脂指標(biāo);采用SYSMEX五分類血液分析儀XE-5000檢測(cè)PLT(platelet count血小板計(jì)數(shù))、MPV(Mean platelet volume平均血小板體積)、PDW(Platelet distribution width血小板分布寬度)、P-LCR(Large platelet ratio大血小板率)等血小板參數(shù);采用法國STAGO COMPact全自動(dòng)血凝分析儀進(jìn)行PT(prothrombin time凝血酶原時(shí)間)、APTT(Activated partial thromboplastin time活化部分凝血活酶時(shí)間)、TT(Thrombin time凝血酶時(shí)間)、FIB(Fibrinogen纖維蛋白原)等凝血相關(guān)指標(biāo);采用發(fā)色底物法檢測(cè)AT-Ⅲ(Antithrombin III抗凝血酶-Ⅲ)水平,采用免疫比濁法檢測(cè)D-D(D-two polymer D-二聚體)、VWF(Von Willebrand factor血管性假血友病因子)水平。結(jié)果:1 3組性別、年齡、吸煙人群比例無顯著性差異(P0.05);與對(duì)照組比較,高血壓組及高血壓T2DM組SBP(systolic pressure收縮壓)、DBP(diastolic pressure舒張壓)、MABP(mean arterial pressure mean arterial pressure)、脈壓及BMI(Body mass index體質(zhì)量指數(shù))明顯升高(P0.01),但高血壓組及高血壓T2DM組2組間無顯著性差異。2與對(duì)照組比較,高血壓組及高血壓T2DM組FPG(Fasting blood glucose空腹血糖)、2hPG(Postprandial 2 h blood glucose餐后2 h血糖)、HbAlc(glycosylated hemoglobin糖化血紅蛋白)、TC(total cholesterol總膽固醇)、TG(triglyceride甘油三酯)、LDL-C(Low density lipoprotein cholesterol低密度脂蛋白膽固醇)明顯升高,HDL-C(High density lipoprotein cholesterol高密度脂蛋白膽固醇)明顯降低(P0.05或P0.01);與高血壓組比較,高血壓T2DM組FPG、2hPG、HbAlc、TC、TG、LDL-C明顯升高,HDL-C明顯降低(P0.05或P0.01)。3與對(duì)照組比較,高血壓組及高血壓T2DM組PLT、MPV、PDW、P-LCR明顯升高(P0.01);與高血壓組比較,高血壓T2DM組PLT、MPV、PDW、P-LCR明顯升高(P0.01)。4與對(duì)照組比較,高血壓組及高血壓T2DM組PT、APTT明顯降低,FIB明顯升高(P0.01);與高血壓組比較,高血壓T2DM組PT、APTT明顯降低,FIB明顯升高(P0.01)。TT在3組間無顯著性差異(P0.05)。5與對(duì)照組比較,高血壓組及高血壓T2DM組AT-Ⅲ明顯降低,D-D、VWF明顯升高(P0.01);與高血壓組比較,高血壓T2DM組AT-Ⅲ明顯降低,D-D、VWF明顯升高(P0.05或P0.01)。結(jié)論:1血小板參數(shù)及凝血四項(xiàng)檢測(cè)可靈敏地反映原發(fā)性高血壓及合并T2DM患者的凝血功能是否存在異常。2高血壓合并T2DM患者較原發(fā)性高血壓患者凝血異常更為明顯。3原發(fā)性高血壓及合并T2DM患者存在血管內(nèi)皮細(xì)胞損傷和血液高凝狀態(tài),檢測(cè)AT-Ⅲ、D-D、VWF等PTS分子標(biāo)志物可為防治高血壓合并T2DM患者發(fā)生血栓事件提供一定的依據(jù)。
[Abstract]:Objective: the proportion of primary hypertension with type 2 diabetes (Type 2 diabetes mellitus) is higher. Hypertension and diabetes can cause multiple target organ damage, especially the risk of cardio cerebral vascular thrombosis. Abnormal thrombocytopenia, coagulation and fibrinolysis can cause the patients to form prethrombotic state and then increase their hair. The risk of cardio cerebral vascular thrombosis. This study was to explore the relationship and clinical significance of platelet parameters, blood coagulation indexes and AT- III, D-D and VWF levels in patients with essential hypertension and hypertension combined with type 2 diabetic glucose. Methods: the relationship between vascular endothelial dysfunction and coagulation was examined. Methods: from January 2016 to October 2016, Hypertension combined with T2DM (Type 2 diabetes mellitus 2 diabetes) patients (hypertension T2DM, n=50) and non diabetic primary hypertension patients (hypertension group, n=50) were admitted to the heart of the General Hospital of Renqiu Petroleum Administration General Hospital of North China National Petroleum Administration, and 25 cases of healthy health examination were selected as control group at the same time. The blood glucose and blood lipid indexes were measured by the instrument, and the SYSMEX five classification blood analyzer XE-5000 was used to detect the PLT (platelet count platelet count), MPV (Mean platelet volume mean platelet volume), PDW (Platelet distribution platelet distribution width) and other platelet parameters. PT (prothrombin time prothrombin time), APTT (Activated partial thromboplastin time activated partial thromboplastin time), TT (Thrombin time thrombin time), FIB (fibrinogen) and other coagulation related indexes were performed by full automatic hemagglutination analyzer. The level of D-D (D-two polymer D- two polymer) and VWF (Von Willebrand factor vascular pseudomophilic factor) was detected by immunoturbidimetry. Results: there was no significant difference in the proportion of sex, age, and smoking population in the 13 groups (P0.05), and the hypertension and the SBP systolic pressure of the T2DM group of the hypertension (systolic) were compared with the control group. Diastolic pressure (diastolic pressure), MABP (mean arterial pressure mean arterial pressure), pulse pressure and BMI (Body mass index body mass index) obviously increased (P0.01), but there was no significant difference between the 2 groups of hypertension group and hypertension group. Blood glucose postprandial 2 h blood sugar), HbAlc (glycosylated hemoglobin glycated hemoglobin), TC (total cholesterol total cholesterol), TG (triglyceride triglyceride), LDL-C (low density lipoprotein cholesterol) obviously. Compared with the hypertension group, the FPG, 2hPG, HbAlc, TC, TG, LDL-C in the hypertensive T2DM group increased significantly, and the HDL-C significantly decreased (P0.05 or P0.01). The hypertension group and the hypertension group were significantly higher than those in the control group. Compared with the control group, the PT, APTT and FIB increased significantly in the hypertension group and the T2DM group (P0.01). Compared with the hypertension group, the PT, APTT, and FIB significantly increased in the hypertension group, and the FIB significantly increased (P0.01).TT in the 3 groups (P0.05) was significantly lower than the control group. Higher (P0.01), compared with hypertension group, AT- III in T2DM group was significantly lower in hypertension group, D-D and VWF was significantly increased (P0.05 or P0.01). Conclusion: 1 platelet parameters and four blood coagulation tests can sensitively reflect the coagulation function in patients with primary hypertension and T2DM patients with abnormal.2 hypertension combined with coagulability in patients with essential hypertension than in patients with essential hypertension. There is often more obvious.3 primary hypertension and T2DM patients with vascular endothelial cell injury and hypercoagulable state, and the detection of AT- III, D-D, VWF and other PTS molecular markers can provide a basis for the prevention and treatment of hypertension complicated with T2DM patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1;R587.1

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