2021 年第 12 期 第 16 卷

糖尿病合并高血压患者凝血和纤维蛋白溶解及血液流变学指标的变化及临床意义

Changes and clinical significance of coagulation, fibrinolysis and hemorheological indexes in patients with diabetes mellitus and hypertension

作者：李雅维1王爽2徐佩秋2陈俊臣1岳晶晶3

英文作者：Li Yawei1 Wang Shuang2 Xu Peiqiu2 Chen Junchen1 Yue Jingjing3

单位：1火箭军特色医学中心体检中心，北京100088；2火箭军特色医学中心内分泌科，北京100088；3火箭军特色医学中心内科，北京100088

英文单位：1Medical Examination Center Rocket Force Characteristic Medical Center Beijing 100088 China; 2Department of Endocrinology Rocket Force Characteristic Medical Center Beijing 100088 China; 3Department of Internal Medicine Rocket Force Characteristic Medical Center Beijing 100088 China

关键词：糖尿病；高血压；凝血；纤维蛋白溶解；血液流变学

英文关键词：Diabetesmellitus;Hypertension;Coagulation;Fibrinolysis;Haemorheology

• 摘要：

• 目的 探讨糖尿病合并高血压患者凝血和纤维蛋白溶解及血液流变学指标的变化及临床意义。方法 选取2019年1月至2020年5月火箭军特色医学中心收治的糖尿病合并高血压患者121例。依据合并高血压的分级分为1级高血压组（52例）、2级高血压组（40例）和3级高血压组（29例）。另选择同期本院诊治的40例未合并高血压的糖尿病患者为单纯糖尿病组。分别测定各组患者的凝血指标［凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）］，纤维蛋白溶解指标［D-二聚体、纤维蛋白原降解产物（FDP）、抗凝血酶Ⅲ、血管性血友病因子(vWF)］和血液流变学指标［全血黏度、血浆黏度、血细胞比容、红细胞沉降率（ESR）］，并进行组间交叉比较。结果  1级、2级、3级高血压组患者PT、TT、APTT明显短于单纯糖尿病组，FIB、D-二聚体、FDP、vWF水平明显高于单纯糖尿病组，抗凝血酶Ⅲ水平明显低于单纯糖尿病组，全血黏度［（6.38±0.62）、（6.69±0.81）、（7.18±0.77）mPa·s比（5.98±0.43）mPa·s］、血浆黏度、血细胞比容和ESR明显高于单纯糖尿病组，差异均有统计学意义（均P<0.05）。3级高血压组与1级、2级高血压组比较以上指标差异亦均有统计学意义（均P<0.05）。结论  糖尿病合并高血压患者的凝血及纤维蛋白溶解功能存在明显异常、血黏度增大，其中合3级高血压患者更明显。

• Objective To discuss changes of coagulation, fibrinolysis and hemorheological indexes in patients with diabetes mellitus and hypertension and their clinical significance. Methods From January 2019 to May 2020, 121 patients with diabetes mellitus and hypertension admitted to Rocket Force Characteristic Medical Center were enrolled. According to the classification of hypertension, they were divided into grade 1 hypertension group(52 cases), grade 2 hypertension group(40 cases) and grade 3 hypertension group(29 cases). Another 40 diabetic patients without hypertension in the same period were selected as simple diabetes group. The coagulation indexes［prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT) and fibrinogen(FIB)］, fibrinolysis indexes［D-dimer, fibrin degradation product(FDP), antithrombin Ⅲ and von Willebrand factor(vWF)］ and hemorheological parameters［whole blood viscosity, plasma viscosity, hematocrit and erythrocyte sedimentation rate(ESR)］ of all groups were determined respectively, and were cross compared between groups. Results The PT, TT and APTT in grade 1, 2 and 3 hypertension groups were significantly shorter than those in the simple diabetes group, the levels of FIB, D-dimer, FDP and vWF were significantly higher than those in the simple diabetes group, the level of antithrombin Ⅲ was significantly lower than that in the simple diabetes group, the whole blood viscosity［(6.38±0.62), (6.69±0.81), (7.18±0.77) mPa·s vs (5.98±0.43) mPa·s］, plasma viscosity, hematocrit and ESR were significantly higher than those in the simple diabetes group, and the differences were statistically significant(all P<0.05). Compared with grade 1 and 2 hypertension groups, the differences of the above indexes in grade 3 hypertension group were also statistically signifficant(all P<0.05). Conclusions   The coagulation and fibrinolysis function in patients with diabetes mellitus complicated with hypertension were significantly abnormal and blood viscosity increased. Among them, patients with grade 3 hypertension are more obvious.