【摘要】 目的观察急性冠脉综合征(ACS)合并2型糖尿病患者的凝血功能及其与全球急性冠脉事件注册(GRACE)危险评分的相关性。方法连续入选2012-06~2012-11因ACS在我院住院的患者300例,其中合并2型糖尿病患者(DM组)126例,非糖尿病患者(NDM组)174例。比较两组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、抗凝血酶Ⅲ(ATⅢ)、纤维蛋白原降解产物(FDP)和D-二聚体(D-dimer)以及GRACE危险评分。根据GRACE评分将DM组患者分高危、中危、低危组。结果 DM组的女性比例、血浆Fib、FDP水平以及GRACE评分显著高于NDM组(P<0.05或P<0.01)。DM患者中与GRACE评分低危组相比,高危组的空腹血糖、Fib、FDP及D-dimer水平均显著升高,ATⅢ水平显著降低(P<0.05或P<0.01)。与中危组相比,高危组的ATⅢ水平明显降低(P<0.01),D-dimer水平明显升高(P<0.05)。DM组患者的GRACE危险评分与Fib、FDP和D-dimer成正相关(r=0.275,0.608,0.408,均P<0.01),与ATⅢ成负相关(r=-0.376,P<0.01)。结论 ACS合并2型糖尿病患者存在更显著的高凝状态,其凝血功能指标对预后的评估作用与GRACE危险评分具有临床一致性。更多还原

【Abstract】 Objective To explore the correlation between coagulation function and GRACE risk score in acute coronary syndrome( ACS) patients with type 2 diabetes. Methods Three hundred patients with ACS in our hospital from June 2012 to November 2012 were enrolled,including 126 patients with diabetes( DM group) and 174 patients without diabetes( NDM group). Coagulation function parameters( PT,APTT,fibrinogen,ATⅢ,FDP,D-dimer) and GRACE risk scores were compared between the two groups. According to GRACE score,the patients in DM group were divided into high-risk group,medium-risk group and low-risk group. Results The ratio of woman,plasma levels of fibrinogen and FDP,and GRACE risk scores were higher in DM group than in NDM group( P < 0. 05 or P < 0. 01). Compared with GRACE low-risk group,the levels of fasting blood glucose,fibrinogen,FDP and D-dimer in high-risk group were all significantly increased,whereas plasma ATⅢ level decreased( P < 0. 05 or P < 0. 01). Morever,the patients in highrisk group had higher D-dimer level( P < 0. 05) and lower ATⅢ level than in medium-risk group( P < 0. 01). GRACE risk scores in DM group was positively related with fibrinogen,FDP and D-dimer( r = 0. 275,0. 608,0. 408,P < 0. 01),but negatively related with ATⅢ( r =- 0. 376,P < 0. 01). Conclusion ACS patients with type 2 diabetes have more serious hypercoagulative state,and the prognosis of their coagulation parameters has a good consistency with GRACE risk score.更多还原