黄晓敏 向薇 吴伟琼

[摘要] 目的 探討2型糖尿病患者下肢血管病变（PAD）与血纤维蛋白原（FIB）的关系。 方法 选择2012年1月～2013年6月于惠州市中心人民医院内分泌科住院治疗的214例2型糖尿病患者，按彩色多普勒超声检查结果，分为2型糖尿病合并PAD组（PAD组，144例）及无PAD的2型糖尿病组（T2DM组，70例），另选取60例健康人为对照组。分别记录其年龄、性别、糖尿病病程、高血压病史、吸烟史、血压、体重指数（BMI），测定其空腹血糖（FPG）、糖化血红蛋白（HbA1c）、血脂、FIB，比较三组间临床、生化指标及FIB的差异，采用Logistic回归分析筛查2型糖尿病患者PAD危险因素。 结果 ①PAD组及T2DM组BMI、收缩压（SBP）、HbA1c、FPG、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平均高于对照组，差异均有统计学意义（P < 0.05或P < 0.01）；PAD组高密度脂蛋白胆固醇（HDL-C）水平低于对照组，差异有高度统计学意义（P < 0.01）；PAD组糖尿病病程、HbA1c、FPG、TC、LDL-C水平均高于T2DM组，差异均有统计学意义（P < 0.05或P < 0.01）。②PAD组FIB水平高于T2DM组及对照组，差异均有高度统计学意义（P < 0.01）；T2DM组FIB水平高于对照组，差异有统计学意义（P < 0.05）。③经Logistic回归分析显示，2型糖尿病患者PAD危险因素有：HbA1c、FIB、糖尿病病程（OR = 1.729、1.471、1.097，P < 0.05）。 结论 血FIB升高与2型糖尿病PAD的发生密切相关，可能是2型糖尿病患者并发PAD的危险因素之一。

[关键词] 2型糖尿病；下肢血管病变；纤维蛋白原

[中图分类号] R587.2 [文献标识码] A [文章编号] 1673-7210（2016）03（c）-0100-04

[Abstract] Objective To investigate the relationship between the serum fibrinogen （FIB） and the peripheral artery diseases （PAD） in patients with type 2 diabetes mellitus. Methods From January 2012 to June 2013， in Department of Endocrinology， Huizhou Central People's Hospital， 214 patients with type 2 diabetes mellitus were selected. The 214 cases were divided into 2 groups according to the peripheral artery color Doppler ultrasonography： type 2 diabets with PAD group （PAD group， 144 cases） and type 2 diabetes without PAD group （T2DM group， 70 cases）， and 60 healthy people were selected as control group. The clinical data， including age， gender， duration of diabetes， history of hypertension， smoking history， blood pressure， body mass index （BMI） were collected， and the laboratory data， including fasting blood glucose （FPG）， glycosylated hemoglobin （HbA1c）， serum lipids， FIB were assayed， the figures of the three groups were compared. Logistic regression analysis was conducted to identify the risk factors for PAD in patients with type 2 diabetes mellitus. Results ①The levels of BMI， systolic blood press （SBP）， HbA1c， FPG， total cholesterol （TC）， low density lipoprotein cholesterol （LDL-C） in PAD group and T2DM group were significantly higher than those in control group， the differences were statistically significant （P < 0.05 or P < 0.01）. The level of high density lipoprotein cholesterol （HDL-C） in PAD group was significantly lower than that in control group， the difference was statistically significant （P < 0.01）. The levels of duration of diabetes， HbA1c， FPG， TC， LDL-C in PAD group were significantly higher than those in T2DM group， the differences were statistically significant （P < 0.05 or P < 0.01）. ②The FIB level in PAD group was significantly higher than that in T2DM group and control group， the difference was statistically significant （P < 0.01）. The FIB level in T2DM group was significantly higher than that in control group， the difference was statistically significant （P < 0.05）. ③Logistic regression analysis showed that HbA1c， FIB， duration of diabetes were risk factors for PAD in patients with type 2 diabetes mellitus （OR = 1.729， 1.471， 1.097， P < 0.05）. Conclusion Increased level of serum FIB may be closely related to PAD， and it seems to be one of the risk factors for PAD in patients with type 2 diabetes mellitus.

[Key words] Type 2 diabetes mellitus； Peripheral artery diseases； Fibrinogen

下肢血管病变（peripheral artery diseases，PAD）是2型糖尿病患者常见的大血管并发症，是导致2型糖尿病患者残疾乃至死亡的主要原因之一。2型糖尿病患者与非糖尿患者群相比，PAD的发病率明显增高[1]，国外资料显示，85%的糖尿病截肢患者由PAD导致[2]。糖尿病患者长期持续的血糖升高可损害血管内皮细胞，导致患者凝血功能紊乱及慢性炎性反应。研究发现，纤维蛋白原（fibrinogen，FIB）可以反映人体内的凝血情况和炎症水平，又参与动脉粥样硬化的发生，其在糖尿病大血管病变的作用逐渐得到人们的重视[3]。本研究观察了惠州市中心人民医院（以下简称“我院”）2型糖尿病合并PAD患者的FIB水平及无PAD的2型糖尿病患者的FIB水平，旨在探讨FIB与2型糖尿病患者PAD的关系。……