高逸之+王志良+李超男

[摘要] 目的 對比心肌梗死合并糖尿病患者血栓弹力图指标和血小板相关指标的差异，并探讨血栓弹力图（TEG）相关指标与血小板相关指标的相关性。 方法 收集2016年1～12月上海第九人民医院与上海中冶医院114例患者临床资料，分为心肌梗死合并糖尿病组（54例）、糖尿病组（20例）和对照组（40例）。采用单因素方差分析比较各组间的TEG各项指标及血小板相关指标的差异，应用Pearson相关性分析心肌梗死合并糖尿病患者TEG指标及血小板参数之间的相关性。 结果 心肌梗死合并糖尿病组凝血形成速率α角（α-Angle）、凝血块最大强度（MA）、凝血综合指数（CI）、平均血小板体积、大血小板比率、血小板体积分布宽度均高于对照组，凝血反应时间（R）、凝血形成时间（K）低于对照组（P < 0.05）。心肌梗死合并糖尿病患者R值与平均血小板体积呈正相关，α-Angle与平均血小板体积、大血小板比率比率、血小板体积分布宽度呈正相关，MA与血小板比容呈正相关（P < 0.05）。 结论 TEG参数对于心肌梗死合并糖尿病的诊断具有一定参考价值，与血小板相关指标具有较好相关性。

[关键词] 心肌梗死；糖尿病；血栓弹力图；血小板参数；相关性

[中图分类号] R542.2 [文献标识码] A [文章编号] 1673-7210（2018）01（b）-0050-04

[Abstract] Objective To analysis the difference between the indexes of thrombus mapping and platelet related factors in patients with myocardial infarction and diabetes mellitus， and to explore the correlation between the relevant indexes of TEG and the related parameters of platelet. Methods From January to December in 2016， clinical data of 114 patients in Shanghai Ninth People′s Hospital and Shanghai MCC Hospital were collected. They were divided into myocardial infarction combined with diabetes mellitus group （54 cases）， diabetes mellitus group （20 cases） and control group （40 cases）. The differences between TEG indicators and platelet related indicators in each group were analyzed by One-Way ANOVA. The correlation between TEG index and platelet parameters in patients with myocardial infarction combined with diabetes mellitus was analyzed by Pearson correlation. Results The α-Angle， the value of MA， CI， mean platelet volume， platelet large cell ratio and platelet volume distribution width in the myocardial infarction combined with diabetes mellitus group were higher than those in the control group （P < 0.05）. Besides， the value of R and K in the myocardial infarction combined with diabetes mellitus group were lower than those in the control group （P < 0.05）. The R value of myocardial infarction combined with diabetes was positively correlated with the platelet volume distribution width， and the α-angle was positively correlated with mean platelet volume， platelet large cell ratio and platelet volume distribution width， and MA was positively correlated with thrombocytocrit （P < 0.05）. Conclusion TEG parameters have a certain reference value for the diagnosis of myocardial infarction combined with diabetes mellitus， and have a good correlation with platelet related indexes.

[Key words] Myocardial infarction； Diabetes mellitus； Thrombelastography； Platelets parameter； Correlationendprint

血栓弹力图（thrombelastography，TEG）通过图像描绘出血液凝固的过程，是一种判断血液凝固和溶解过程状况的有效方法[1]，主要包括反应凝血因子功能、纤维蛋白水平、血小板数量及功能四项指标构成[2-3]具有检测快速、简便，同时与血小板参数相关性高、误差小的突出优势[4]，在判断凝血状况的评估中作用突出，目前在临床适用范围还在不断拓展。有研究显示凝血功能异常与心肌梗死的发生密切相关[5]，而糖尿病会促使凝血功能增强，增加血小板聚集[6]，因此TEG检测对心肌梗死合并糖尿病的诊断具有重要意义。本研究拟对心肌梗死合并糖尿病患者的TEG及血小板相关指标进行检测，探讨其TEG与血小板参数的特点及其相关关系进一步评估其应用价值提供参考。……