2型糖尿病并發(fā)腦梗死患者頸動脈粥樣硬化與vWF、AT的關(guān)系
發(fā)布時間：2018-08-15 14:00
【摘要】：2型糖尿病是一種常見疾病,腦梗死是大血管并發(fā)癥之一,是糖尿病患者致死、致殘的主要原因之一。UKPDS和ADVANCE研究報告指出:2型糖尿病大血管病變發(fā)病率高,強化降糖治療對于大血管病變沒有顯著療效。提醒我們要重視對大血管并發(fā)癥的預(yù)防,對2型糖尿病患者實施早期篩查和治療以預(yù)防腦梗死的發(fā)生是十分必要的。目前認(rèn)為2型糖尿病并發(fā)大血管病變的病理基礎(chǔ)是動脈粥樣硬化,血管內(nèi)皮細(xì)胞受損,致血管內(nèi)壁狹窄,容易促進(jìn)局部血栓的形成。動脈粥樣硬化尤其是向腦部供應(yīng)血液的頸部血管發(fā)生動脈粥樣硬化,造成的血管內(nèi)徑狹窄或斑塊墜落是導(dǎo)致缺血性腦血管事件的主要原因。研究發(fā)現(xiàn),2型糖尿病并發(fā)腦梗死患者通常會存在血管內(nèi)皮細(xì)胞系統(tǒng)、凝血、抗凝及纖溶系統(tǒng)的異常變化。血管性血友病因子(vWF)是目前公認(rèn)的血管內(nèi)皮受損和功能紊亂的血漿標(biāo)志物,與動脈血栓性疾病的發(fā)生及預(yù)后聯(lián)系密切。多項臨床研究均表明,急性腦梗死患者血漿vWF水平顯著性升高,提示血漿vWF水平增高可能與缺血性腦卒中的病理狀況相關(guān)。據(jù)相關(guān)文獻(xiàn)報道,腦梗死尤其是在急性期,機體處于高凝狀態(tài),抗凝血酶(AT)被大量消耗,造成血管內(nèi)凝血功能亢進(jìn),同時AT合成減少,提示AT參與腦梗死凝血功能障礙這一病理生理過程�，F(xiàn)階段,2型糖尿病并發(fā)腦梗死的發(fā)病原理仍尚未完全明確,因此,掌握2型糖尿病并發(fā)腦梗死的發(fā)病機制將是進(jìn)行有針對性的治療的關(guān)鍵。目的:本研究旨在觀察2型糖尿病并發(fā)腦梗死患者頸動脈粥樣硬化狀況與血漿中vWF、AT的表達(dá),分析其與2型糖尿病合并腦梗死病變過程的關(guān)聯(lián)性,探討糖尿病腦梗死的相關(guān)機制,從而為臨床上防治2型糖尿病腦血管事件提供一定依據(jù)。方法:選取2015年12月到2016年5月間在承德市中心醫(yī)院就診的125例患者,將入選者分為三組:(1)2型糖尿病并發(fā)腦梗死組(DMCI組),n=44;(2)2型糖尿病組(DM組),n=51。(3)對照組(CN組),n=30:為同期在本院體檢中心體檢的健康人群。依據(jù)是否存在頸動脈粥樣硬化斑塊,進(jìn)一步將各組分為有動脈斑塊組(EAP組)、無動脈斑塊組(NAP組);再依據(jù)斑塊的不同性質(zhì),將EAP組分為穩(wěn)定斑塊組(SP組)和不穩(wěn)定斑塊組(USP組)。全部收錄對象近一個月內(nèi)未服用過促凝、抗凝及溶栓類藥物。三組在年齡、性別等一般資料上具有均衡性。詳細(xì)詢問所有入選對象的病史,測量并記錄身高、體重、血壓、糖尿病病程、吸煙史,并計算體重指數(shù)(BMI)。取空腹靜脈血,采取免疫比濁法測定血漿vWF水平;采取發(fā)色底物法測定血漿AT水平;應(yīng)用全自動生化分析儀測定甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C);采取液相色譜法測定糖化血紅蛋白(Hb A1c);采用彩色多普勒超聲儀檢測三組頸動脈斑塊情況。采用SPSS19.0軟件進(jìn)行統(tǒng)計學(xué)分析,符合正態(tài)分布的計量資料用均數(shù)±標(biāo)準(zhǔn)差(?)表示,兩組間比較采用t檢驗,三組間比較采用方差分析(兩兩比較采用LSD法),計數(shù)資料采用χ~2檢驗,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1三組間一般資料的比較(1)三組在年齡、BMI方面的差別無統(tǒng)計學(xué)意義,P=0.522、P=0.1(P0.05),三組在性別、吸煙史方面的差異無統(tǒng)計學(xué)意義,χ~2=3.56,P=0.169(P0.05)、χ~2=2.688,P=0.1261(P0.05);(2)DMCI組的DM病程長于DM組,差別有統(tǒng)計學(xué)意義,P=0.043(P0.05)。2三組間生化指標(biāo)的比較三組在vWF、AT、Hb A1c、TC、HDL-C的差別有統(tǒng)計學(xué)意義(P0.05);三組在TG、LDL-C的差別不存在統(tǒng)計學(xué)意義(P0.05);組間比較:DMCI組的vWF、Hb A1c、TC均高于DM組和CN組(P0.05或P0.01),且DM組高于CN組(P0.05或P0.01);DMCI組的AT、HDL-C均低于DM組和CN組(P0.05或P0.01),且DM組低于CN組(P0.05)。3三組間超聲指標(biāo)的比較(1)三組頸動脈斑塊檢出率的比較三組在頸動脈斑塊檢出率之間的差別具有統(tǒng)計學(xué)意義(P0.01);組間比較:DMCI組與DM組的頸動脈斑塊檢出率均高于CN組(χ~2=27.81,P0.01、χ~2=4.67,P0.05);DMCI組的頸動脈斑塊檢出率高于DM組(χ~2=13.44,P0.01)。(2)三組不同性質(zhì)頸動脈斑塊檢出率的比較三組在頸動脈不同性質(zhì)斑塊檢出率方面的差別具有統(tǒng)計學(xué)意義(P0.01);組間比較:DMCI組的頸動脈不穩(wěn)定性斑塊檢出率高于DM組、CN組,(χ~2=5.77,P0.05、χ~2=8.51,P0.01),差別有統(tǒng)計學(xué)意義;DM組的頸動脈不穩(wěn)定性斑塊檢出率高于CN組,但是差別不存在統(tǒng)計學(xué)意義(χ~2=1.59,P0.05)。4 DMCI組患者各指標(biāo)的相關(guān)性(1)vWF水平與DMCI各亞組頸動脈斑塊性質(zhì)的關(guān)系(?)DMCI組患者vWF水平顯著高于DM組(P0.05)。DMCI組內(nèi)不穩(wěn)定斑塊患者vWF水平顯著高于穩(wěn)定斑塊、無斑塊患者的vWF水平,差異有統(tǒng)計學(xué)意義(P=0.023,P0.05、P=0.016,P0.01);穩(wěn)定斑塊患者vWF水平高于無斑塊患者,但差別不存在統(tǒng)計學(xué)意義(P=0.129,P0.05)。(2)AT水平與DMCI各亞組頸動脈斑塊性質(zhì)的關(guān)系(?)DMCI組患者AT水平顯著低于DM組(P0.05)。DMCI組不穩(wěn)定斑塊患者AT水平低于穩(wěn)定斑塊、無斑塊患者的AT水平,差異具有統(tǒng)計學(xué)意義(P=0.038,P0.05、P=0.02,P0.05);穩(wěn)定斑塊患者AT水平與無斑塊患者AT水平之間的差異不具有統(tǒng)計學(xué)意義(P=0.103,P0.05)。結(jié)論:1 2型糖尿病并發(fā)腦梗死患者發(fā)生頸動脈粥樣硬化斑塊的病變率明顯增高。2 2型糖尿病并發(fā)腦梗死患者的血漿vWF水平與頸動脈粥樣硬化相關(guān),斑塊越不穩(wěn)定vWF水平升高越顯著。vWF在一定程度上可以反映頸動脈粥樣硬化斑塊的性質(zhì),可作為輔助臨床診療和反映疾病進(jìn)展的一項非損傷性指標(biāo)。3 2型糖尿病并發(fā)腦梗死患者的血漿AT水平與頸動脈粥樣硬化相關(guān),斑塊越不穩(wěn)定AT水平降低越明顯。AT在一定程度上可以反映頸動脈粥樣硬化斑塊的性質(zhì)。4 2型糖尿病并發(fā)急性腦梗死患者血管內(nèi)皮功能損傷越重,頸動脈粥樣硬化斑塊越不穩(wěn)定,降低vWF水平、增高AT水平,對于防治2型糖尿病患者發(fā)生頸動脈粥樣硬化和腦梗死具有重要意義。
[Abstract]:Type 2 diabetes mellitus is a common disease. Cerebral infarction is one of the complications of large vessels and one of the main causes of death and disability in diabetic patients. Early screening and treatment of type 2 diabetes mellitus is necessary to prevent cerebral infarction. Atherosclerosis, vascular endothelial cell damage, vascular wall stenosis, and local thrombosis are the pathological basis of type 2 diabetes with macroangiopathy. The main cause of ischemic cerebrovascular events is atherosclerosis of the cervical vessels supplying blood to the brain, resulting in narrow vessel diameters or falling plaques. Studies have found that patients with type 2 diabetes complicated by cerebral infarction usually have abnormal changes in the vascular endothelial cell system, coagulation, anticoagulation and fibrinolysis system. Etiological factors (vWF) are recognized as plasma markers of vascular endothelial damage and dysfunction, and are closely related to the occurrence and prognosis of arterial thrombotic diseases. Several clinical studies have shown that the plasma vWF levels in patients with acute cerebral infarction are significantly elevated, suggesting that the elevated plasma vWF levels may be related to the pathological status of ischemic stroke. Relevant literatures reported that cerebral infarction, especially in acute phase, is in hypercoagulable state, and antithrombin (AT) is consumed in large quantities, resulting in hypercoagulability in blood vessels, and AT synthesis is reduced, suggesting that AT participates in the pathophysiological process of coagulation dysfunction in cerebral infarction. Objective: To investigate the relationship between carotid atherosclerosis and the expression of vWF and AT in plasma of type 2 diabetes mellitus patients with cerebral infarction, and to explore the relationship between the expression of vWF and AT and the process of type 2 diabetes mellitus complicated with cerebral infarction. Methods: From December 2015 to May 2016, 125 patients in Chengde Central Hospital were divided into three groups: (1) type 2 diabetes complicated with cerebral infarction group (DMCI group), n = 44; (2) type 2 diabetes mellitus group (DM group), n = 51. (3) pairs The control group (CN group), n = 30: healthy people who were checked up in the physical examination center of our hospital at the same time. According to the existence of carotid atherosclerotic plaques, each group was further divided into arterial plaque group (EAP group), non-arterial plaque group (NAP group); and then according to the different nature of the plaque, EAP group was divided into stable plaque group (SP group) and unstable plaque group (USP group). The subjects did not take anticoagulant, anticoagulant and thrombolytic drugs in the past month. The three groups were balanced in age and sex. All the subjects were asked about their medical history, height, weight, blood pressure, duration of diabetes, smoking history, and body mass index (BMI). Fasting venous blood was taken and measured by immunoturbidimetric method. The levels of plasma vWF, AT, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (Hb A1c) and color Doppler ultrasonography (CDU) were used to detect the three groups. Carotid plaque was analyzed by SPSS19.0 software. The normal distribution measurement data were expressed by mean (?) standard deviation. The comparison between the two groups was performed by t test. The comparison among the three groups was performed by analysis of variance (two comparisons were performed by LSD method). The counting data were analyzed by_~2 test. The difference was statistically significant (P 0.05). There was no significant difference in age and BMI among the three groups (P = 0.522, P = 0.1 (P 0.05). There was no significant difference in sex and smoking history among the three groups, _~2 = 3.56, P = 0.169 (P 0.05), _~2 = 2.688, P = 0.1261 (P 0.05); (2) The duration of DM in DMCI group was longer than that in DM group (P = 0.043) (P 0.05). There were significant differences in VWF, AT, Hb A1c, TC, HDL-C among the three groups (P 0.05); there was no significant difference in TG, LDL-C among the three groups (P 0.05); the comparison among the three groups: vWF, Hb A1c, TC in DMCI group were higher than those in DM group and CN group (P 0.05 or P 0.01), and the AT, HDL-C in DM group were lower than those in DM group and CN group (P 0.05 or P 0.01); the AT, HDL-C in DMCI group were lower than those in DM group and CN group (P 0.05 or P 0.01). The detection rate of carotid plaque in DMCI group and DM group was higher than that in CN group (_~2=27.81, P 0.01, _~2=4.67, P 0.05). The detection rate of carotid plaque in DMCI group was higher than that in DM group (_~2=13.44, P 0.01). (2) The detection rate of carotid plaque in three groups was statistically significant (P 0.01); the detection rate of carotid unstable plaque in DMCI group was higher than that in DM group, CN group (_~2=5.77, P 0.05, _~2=8.51, P 0.01). The detection rate of carotid artery unstable plaque in DM group was higher than that in CN group, but there was no significant difference (_~2=1.59, P 0.05). 4 The correlation between vWF level and carotid artery plaque properties in DMCI group was significant (1) The vWF level in DMCI group was significantly higher than that in DM group (P 0.05). The level of vWF in patients with stable plaque was significantly higher than that in patients without stable plaque (P = 0.023, P 0.05, P = 0.016, P 0.01); the level of vWF in patients with stable plaque was higher than that in patients without plaque, but the difference was not statistically significant (P = 0.129, P 0.05). (2) The relationship between AT level and the nature of carotid plaque in DMCI subgroups (?) The AT level of patients with unstable plaque was lower than that of patients without stable plaque (P = 0.038, P 0.05, P = 0.02, P 0.05). There was no significant difference between AT level of patients with stable plaque and that of patients without plaque (P = 0.103, P 0.05). The incidence of carotid atherosclerotic plaque in patients with diabetes mellitus complicated with cerebral infarction was significantly increased. The plasma vWF level in patients with type 2 diabetes complicated with cerebral infarction was associated with carotid atherosclerosis. The more unstable the plaque, the higher the vWF level was. The vWF could reflect the nature of carotid atherosclerotic plaque to some extent and could be used as an adjuvant. 3. The plasma AT level in type 2 diabetes mellitus patients with cerebral infarction is associated with carotid atherosclerosis, and the more unstable the plaque, the more obvious the decrease of AT level. AT can reflect the nature of carotid atherosclerotic plaque to a certain extent. 4. Type 2 diabetes mellitus patients with acute cerebral infarction The more serious vascular endothelial dysfunction, the more unstable carotid atherosclerotic plaque, the lower the level of vWF, the higher the level of AT, for the prevention and treatment of type 2 diabetes carotid atherosclerosis and cerebral infarction is of great significance.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R743.33
本文編號：2184420
[Abstract]:Type 2 diabetes mellitus is a common disease. Cerebral infarction is one of the complications of large vessels and one of the main causes of death and disability in diabetic patients. Early screening and treatment of type 2 diabetes mellitus is necessary to prevent cerebral infarction. Atherosclerosis, vascular endothelial cell damage, vascular wall stenosis, and local thrombosis are the pathological basis of type 2 diabetes with macroangiopathy. The main cause of ischemic cerebrovascular events is atherosclerosis of the cervical vessels supplying blood to the brain, resulting in narrow vessel diameters or falling plaques. Studies have found that patients with type 2 diabetes complicated by cerebral infarction usually have abnormal changes in the vascular endothelial cell system, coagulation, anticoagulation and fibrinolysis system. Etiological factors (vWF) are recognized as plasma markers of vascular endothelial damage and dysfunction, and are closely related to the occurrence and prognosis of arterial thrombotic diseases. Several clinical studies have shown that the plasma vWF levels in patients with acute cerebral infarction are significantly elevated, suggesting that the elevated plasma vWF levels may be related to the pathological status of ischemic stroke. Relevant literatures reported that cerebral infarction, especially in acute phase, is in hypercoagulable state, and antithrombin (AT) is consumed in large quantities, resulting in hypercoagulability in blood vessels, and AT synthesis is reduced, suggesting that AT participates in the pathophysiological process of coagulation dysfunction in cerebral infarction. Objective: To investigate the relationship between carotid atherosclerosis and the expression of vWF and AT in plasma of type 2 diabetes mellitus patients with cerebral infarction, and to explore the relationship between the expression of vWF and AT and the process of type 2 diabetes mellitus complicated with cerebral infarction. Methods: From December 2015 to May 2016, 125 patients in Chengde Central Hospital were divided into three groups: (1) type 2 diabetes complicated with cerebral infarction group (DMCI group), n = 44; (2) type 2 diabetes mellitus group (DM group), n = 51. (3) pairs The control group (CN group), n = 30: healthy people who were checked up in the physical examination center of our hospital at the same time. According to the existence of carotid atherosclerotic plaques, each group was further divided into arterial plaque group (EAP group), non-arterial plaque group (NAP group); and then according to the different nature of the plaque, EAP group was divided into stable plaque group (SP group) and unstable plaque group (USP group). The subjects did not take anticoagulant, anticoagulant and thrombolytic drugs in the past month. The three groups were balanced in age and sex. All the subjects were asked about their medical history, height, weight, blood pressure, duration of diabetes, smoking history, and body mass index (BMI). Fasting venous blood was taken and measured by immunoturbidimetric method. The levels of plasma vWF, AT, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), glycosylated hemoglobin (Hb A1c) and color Doppler ultrasonography (CDU) were used to detect the three groups. Carotid plaque was analyzed by SPSS19.0 software. The normal distribution measurement data were expressed by mean (?) standard deviation. The comparison between the two groups was performed by t test. The comparison among the three groups was performed by analysis of variance (two comparisons were performed by LSD method). The counting data were analyzed by_~2 test. The difference was statistically significant (P 0.05). There was no significant difference in age and BMI among the three groups (P = 0.522, P = 0.1 (P 0.05). There was no significant difference in sex and smoking history among the three groups, _~2 = 3.56, P = 0.169 (P 0.05), _~2 = 2.688, P = 0.1261 (P 0.05); (2) The duration of DM in DMCI group was longer than that in DM group (P = 0.043) (P 0.05). There were significant differences in VWF, AT, Hb A1c, TC, HDL-C among the three groups (P 0.05); there was no significant difference in TG, LDL-C among the three groups (P 0.05); the comparison among the three groups: vWF, Hb A1c, TC in DMCI group were higher than those in DM group and CN group (P 0.05 or P 0.01), and the AT, HDL-C in DM group were lower than those in DM group and CN group (P 0.05 or P 0.01); the AT, HDL-C in DMCI group were lower than those in DM group and CN group (P 0.05 or P 0.01). The detection rate of carotid plaque in DMCI group and DM group was higher than that in CN group (_~2=27.81, P 0.01, _~2=4.67, P 0.05). The detection rate of carotid plaque in DMCI group was higher than that in DM group (_~2=13.44, P 0.01). (2) The detection rate of carotid plaque in three groups was statistically significant (P 0.01); the detection rate of carotid unstable plaque in DMCI group was higher than that in DM group, CN group (_~2=5.77, P 0.05, _~2=8.51, P 0.01). The detection rate of carotid artery unstable plaque in DM group was higher than that in CN group, but there was no significant difference (_~2=1.59, P 0.05). 4 The correlation between vWF level and carotid artery plaque properties in DMCI group was significant (1) The vWF level in DMCI group was significantly higher than that in DM group (P 0.05). The level of vWF in patients with stable plaque was significantly higher than that in patients without stable plaque (P = 0.023, P 0.05, P = 0.016, P 0.01); the level of vWF in patients with stable plaque was higher than that in patients without plaque, but the difference was not statistically significant (P = 0.129, P 0.05). (2) The relationship between AT level and the nature of carotid plaque in DMCI subgroups (?) The AT level of patients with unstable plaque was lower than that of patients without stable plaque (P = 0.038, P 0.05, P = 0.02, P 0.05). There was no significant difference between AT level of patients with stable plaque and that of patients without plaque (P = 0.103, P 0.05). The incidence of carotid atherosclerotic plaque in patients with diabetes mellitus complicated with cerebral infarction was significantly increased. The plasma vWF level in patients with type 2 diabetes complicated with cerebral infarction was associated with carotid atherosclerosis. The more unstable the plaque, the higher the vWF level was. The vWF could reflect the nature of carotid atherosclerotic plaque to some extent and could be used as an adjuvant. 3. The plasma AT level in type 2 diabetes mellitus patients with cerebral infarction is associated with carotid atherosclerosis, and the more unstable the plaque, the more obvious the decrease of AT level. AT can reflect the nature of carotid atherosclerotic plaque to a certain extent. 4. Type 2 diabetes mellitus patients with acute cerebral infarction The more serious vascular endothelial dysfunction, the more unstable carotid atherosclerotic plaque, the lower the level of vWF, the higher the level of AT, for the prevention and treatment of type 2 diabetes carotid atherosclerosis and cerebral infarction is of great significance.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R743.33
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