本文選題：2型糖尿病 + 初診�。� 參考：《新鄉(xiāng)醫(yī)學院》2015年碩士論文

【摘要】：背景糖尿病是一種因胰島素分泌和(或)作用缺陷所引起的以慢性血葡萄糖水平增高為主要特征的代謝性疾病。該病為臨床常見病和多發(fā)病之一,近年來隨著人們生活水平提高、人口老齡化以及生活方式改變,糖尿病的患病率明顯升高,患病人數也逐年攀升。有統(tǒng)計顯示,與過去20年相比糖尿病患者上升了4倍之多。在我國,截至目前糖尿病患者多達9200萬人以上,位居全球之首。2型糖尿病約占糖尿病患者總人數的90%以上,據報道,每10s就有一位糖尿病患者死于糖尿病相關并發(fā)癥,其死亡率接近于艾滋病。糖尿病主要危害患者的心、腦、腎、神經、血管、皮膚等,且上述危害常常在不知不覺中發(fā)生,其嚴重性已引起了人們的廣泛關注。研究指出,40歲初診2型糖尿病患者的平均壽命與普通人群相比要減少8年,其中心血管事件為該病的第一位死亡原因。有報道顯示,糖尿病患者冠心病的發(fā)生率約為65%,心血管事件發(fā)生率約為普通人群的2-4倍,而糖尿病伴發(fā)心血管并發(fā)癥患者中死于急性心肌缺血并發(fā)癥的約占75%。大量研究證實,2型糖尿病可造成神經、血管、以及多系統(tǒng)、多組織損傷,相關并發(fā)癥多,且腦血管疾病、高血壓、冠心病和周圍血管疾病的發(fā)病風險較高。國內外相關研究證實,糖尿病患者多因血管病變致殘或死亡其中約80%的患者死于血栓疾病。2型糖尿病患者抗凝及纖溶活性降低、凝血活性亢進,出現凝血——纖溶功能紊亂,血液處于高凝狀態(tài),伴有并發(fā)癥時其血液高凝狀態(tài)更加明顯。目前,如何通過早期干預緩解2型糖尿病患者的高凝血狀態(tài),有效改善糖尿病患者的凝血功能,已成為臨床醫(yī)務人員面臨的重要問題。目的探討胰島素強化治療對初診2型糖尿病(Type 2 diabetes mellitus,T2DM)患者凝血功能的影響。對象與方法選取于2013年9月～2014年9月入我院內分泌科就診的2型糖尿病患者60例,糖尿病診斷及分類符合1999年世界衛(wèi)生組織(WHO)標準,均為新診斷2型糖尿病患者,將其設為治療組；以同期入我院接受體檢的健康人60例作為對照,設為對照組。空腹抽血測定FBG、2PBG、HbA1c、血脂、胰島素和凝血指標：凝血酶原時間、部分活化凝血活酶時間和國際標準化比值。對治療組患者行胰島素強化治療3個月,之后停用外源性胰島素,空腹抽血測定其凝血指標、HbA1c、FBG、2PBG、血脂。計算胰島素β細胞功能(Homaβ)及胰島素抵抗指數IR (HomaIR)、于治療前后比較治療組上述指標的變化情況,并將治療組上述指標與對照組進行比較。結果治療組和對照組的性別、年齡、體質指數(BMI)等一般資料無統(tǒng)計學差異(P0.05),具有可比性。經胰島素強化治療前治療組患者的FBG、2PBG、HbA1c、膽固醇(Cholesterol,TC)、低密度脂蛋白(Low-density lipoprotein,LDL)、甘油三酯(Triglyceride,TG)明顯高于對照組(P0.05),高密度脂蛋白(High density lipoprotein, HDL)和Homaβ下降,HomaIR升高,凝血酶原時間(Prothrombin time, PT)、部分活化凝血活酶時間(Activated partial thromboplastin time, APTT)和國際標準化比值(International normalized ratio,INR)均明顯縮短,凝血活酶時間(Thromboplastin time,TT)則無明顯改變。經治療后治療組患者的FBG、2PBG、 HbA1c、TG均明顯下降,HDL升高,Homaβ和HomaIR明顯改善,PT、APTT和INR等凝血指標均明顯延長,與該組治療前比較均有顯著性差異(P0.05),但其FBG、2PBG、HbAlc、TG、LDL仍高于對照組,Homaβ下降,HomaIR升高,PT、APTT和INR等凝血指標明顯縮短,比較差異均有統(tǒng)計學意義(P0.05)。結論初診2型糖尿病患者存在高凝血狀態(tài),經胰島素強化治療可有效改善其凝血功能；經胰島素強化治療后患者的凝血功能未恢復至正常水平,可能與其血糖血脂水平未完全恢復正常有關。
[Abstract]:Background diabetes is a metabolic disease characterized by high levels of chronic blood glucose caused by insulin secretion and or (or) deficiency. This disease is one of the common and frequently occurring diseases. In recent years, the prevalence of diabetes is significantly increased with the improvement of people's living standards, the aging of the population and the change of lifestyle. The number of patients also rises year by year. There are statistics showing that diabetic patients have risen more than 4 times as much as the past 20 years. In China, up to now, there are more than 92 million diabetic patients, more than 90% of the total number of diabetic patients in the world are the first.2 type diabetes, and one diabetic patient per 10s is reported to have died of diabetes related The mortality rate is close to AIDS. Diabetes mainly endangering patients' heart, brain, kidney, nerve, blood vessel, skin and so on, and the above harm often occurs unwittingly, and its severity has caused widespread concern. The study indicates that the average life span of 40 year old patients with type 2 diabetes should be reduced by 8 years compared with those of the general population. The incidence of cardiovascular events is the first cause of death in the disease. It is reported that the incidence of coronary heart disease in diabetic patients is about 65%, the incidence of cardiovascular events is about 2-4 times that of the general population, and diabetes associated with complications of acute myocardial ischemia in patients with cardiovascular complications has been confirmed by a large number of 75%. studies, and type 2 diabetes can cause God. The risk of cerebrovascular disease, hypertension, coronary heart disease and peripheral vascular disease is higher in meridian, blood vessels, and multiple systems. Related studies at home and abroad have confirmed that about 80% of patients with diabetic patients died of thrombotic disease, the anticoagulant and fibrinolytic activity of type.2 diabetic patients with thrombotic disease. Lowering, hypercoagulability, coagulation, fibrinolysis, blood in hypercoagulable state, and hypercoagulable state with complications, how to relieve the hypercoagulable state of type 2 diabetic patients by early intervention and effectively improve the blood coagulation function of diabetic patients has become a serious problem faced by clinical medical staff. Objective to investigate the effect of intensive insulin therapy on coagulation function in patients with type 2 diabetes (Type 2 diabetes mellitus, T2DM). Objects and methods were selected in 60 cases of type 2 diabetic patients admitted to our department of Endocrinology from September 2013 to 9 months of 2014. The diagnosis and classification of diabetes were in accordance with the WHO (WHO) standard in 1999. For the new diagnosis of type 2 diabetes, the patients were set up as the treatment group, and 60 healthy people who received physical examination in our hospital at the same time were used as the control group. The FBG, 2PBG, HbA1c, blood lipid, insulin and coagulation indexes were measured by fasting blood, and the time of prothrombin, the time of activation of blood coagulation enzyme and the international standardized ratio. Isisin was treated for 3 months, then exogenous insulin was discontinued, and blood coagulation index, HbA1c, FBG, 2PBG, and blood lipid were measured on empty stomach. The changes of insulin beta cell function (Homa beta) and insulin resistance index IR (HomaIR) were calculated, and the changes of the above indexes in the treatment group were compared before and after treatment, and the above indexes in the treatment group were compared with the control group. The general data of sex, age and body mass index (BMI) in the treatment group and the control group had no statistical difference (P0.05), which was comparable. The FBG, 2PBG, HbA1c, Cholesterol, TC, low density lipoprotein (Low-density lipoprotein, LDL), and triglyceride (Triglyceride, TG) in the pre treatment group were significantly higher than those in the control group. (P0.05), high density lipoprotein (High density lipoprotein, HDL) and Homa beta decreased, HomaIR increased, prothrombin time (Prothrombin time, PT), partial activated thromboplastin time (Activated partial) and international standardization ratio were significantly shortened, and thromboplastin time Romboplastin time, TT) did not change obviously. After treatment, the patients with FBG, 2PBG, HbA1c, TG were significantly decreased, HDL increased, Homa beta and HomaIR obviously improved, PT, APTT, and other coagulation indexes were significantly longer, compared with the group before treatment, but it was still higher than the control group. The blood coagulation indexes of omaIR, PT, APTT and INR were significantly shortened, and the differences were statistically significant (P0.05). Conclusion the patients with type 2 diabetes have high coagulation status, and the coagulation function can be effectively improved by intensive insulin therapy. The coagulation function of the patients after intensive insulin treatment is not restored to normal level, and may be related to blood glucose blood. The level of lipid is not fully restored to normal.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R587.1

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