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Zhao Heng, 1,* Zhang Lidan, 2,* Liu Lifang, 1 Li Chunqing, 3 Song Weili, 3 Peng Yongyang, 1 Zhang Yunliang, 1 Li Dan 41 Cibiyar Nazarin Endocrinology, Babban Asibitin Baoding na Farko, Baoding, Lardin Hebei, 071002 Baoding Sashen Farko na Magungunan Nukiliya, Babban Asibitin, Baoding, Hebei 071000;3 Sashen Marasa lafiya na Babban Asibitin Baoding na Farko, Baoding, Lardin Hebei, 071000;4 Sashen Nazarin Ophthalmology, Asibitin Haɗin Kan Jami'ar Hebei, Baoding, Hebei, 071000 *Wadannan marubutan sun ba da gudummawa daidai da wannan aikin.Marubucin da ya dace: Li Dan, Sashen Nazarin Ido, Asibitin Jami'ar Hebei, Baoding, Hebei, 071000 Tel +86 189 31251885 Fax +86 031 25981539 Email [email protected] Zhang Yunliang Endocrinology Laboratory, Baovince00 Jamhuriyar Sin Tel +86 151620373737373737375axe Email protected Manufa: Wannan binciken yana da nufin bayyana matakan haemoglobin glycosylated (HbA1c), D-dimer (DD) da fibrinogen (FIB) a cikin nau'ikan cututtukan cututtukan ciwon sukari (DR).Hanyar: An zaɓi jimlar masu ciwon sukari 61, waɗanda suka karɓi magani a sashinmu daga Nuwamba 2017 zuwa Mayu 2019.Dangane da sakamakon hotunan da ba na mydriatic fundus da kuma fundus angiography, an raba marasa lafiya zuwa rukuni uku, waɗanda ba DR (NDR) ƙungiyar (n = 23), ƙungiyar DR (NPDR) ba ta haɓaka ba (n = 17) da haɓakawa. Ƙungiyar DR (PDR) (n=21).Hakanan ya haɗa da ƙungiyar kulawa na mutane 20 waɗanda suka gwada rashin lafiyar ciwon sukari.Auna kuma kwatanta matakan HbA1c, DD da FIB bi da bi.Sakamako: Matsakaicin ƙimar HbA1c sun kasance 6.8% (5.2%, 7.7%), 7.4% (5.8%, 9.0%) da 8.5% (6.3%), 9.7%) a cikin ƙungiyoyin NDR, NPDR da PDR, bi da bi. .Ƙimar sarrafawa shine 4.9% (4.1%, 5.8%).Wadannan sakamakon sun nuna cewa akwai gagarumin bambance-bambancen kididdiga tsakanin kungiyoyin.A cikin ƙungiyoyin NDR, NPDR, da PDR, matsakaicin ƙimar DD sune 0.39 ± 0.21 mg/L, 1.06 ± 0.54 mg/L, da 1.39 ± 0.59 mg/L, bi da bi.Sakamakon ƙungiyar kulawa shine 0.36 ± 0.17 mg / L.Ƙimar ƙungiyar NPDR da ƙungiyar PDR sun kasance mafi girma fiye da na ƙungiyar NDR da ƙungiyar kulawa, kuma ƙimar ƙungiyar PDR ta kasance mafi girma fiye da na ƙungiyar NPDR, wanda ke nuna cewa bambanci tsakanin ƙungiyoyi yana da mahimmanci. (P <0.001).Matsakaicin ƙimar FIB a cikin ƙungiyoyin NDR, NPDR, da PDR sune 3.07 ± 0.42 g/L, 4.38 ± 0.54 g/L, da 4.46 ± 1.09 g/L, bi da bi.Sakamakon ƙungiyar kulawa shine 2.97 ± 0.67 g / L.Bambanci tsakanin ƙungiyoyi yana da mahimmanci a ƙididdiga (P <0.05).Ƙarshe: Matakan HbA1c, DD, da FIB a cikin ƙungiyar PDR sun fi girma fiye da waɗanda ke cikin ƙungiyar NPDR.Mahimman kalmomi: glycosylated haemoglobin, HbA1c, D-dimer, DD, fibrinogen, FIB, ciwon sukari retinopathy, DR, microangiopathy.
Ciwon sukari mellitus (DM) ya zama cuta mai yawa a cikin 'yan shekarun nan, kuma rikice-rikicensa na iya haifar da cututtukan tsarin da yawa, wanda microangiopathy shine babban dalilin mutuwa a cikin masu ciwon sukari.1 Glycated haemoglobin (HbA1c) shine babban alamar sarrafa glucose na jini, wanda galibi yana nuna matsakaicin matsakaicin matakin glucose na jini a cikin watanni biyu ko uku na farko, kuma ya zama ma'aunin zinariya da aka sani a duniya don kula da glucose na jini na dogon lokaci na ciwon sukari. .A cikin gwajin aikin coagulation, D-dimer (DD) na iya nuna musamman hyperfibrinolysis na biyu da hypercoagulability a cikin jiki, a matsayin mai nuna alamar thrombosis.Fibrinogen (FIB) taro na iya nuna yanayin prethrombotic a cikin jiki.Binciken da aka gudanar ya nuna cewa saka idanu da aikin coagulation da HbA1c na marasa lafiya tare da DM suna taka rawa wajen yin la'akari da ci gaban cututtukan cututtuka, 2,3 musamman microangiopathy.4 Ciwon jijiyoyi na ciwon sukari (DR) yana ɗaya daga cikin rikice-rikice na microvascular da kuma babban dalilin makanta masu ciwon sukari.Fa'idodin waɗannan nau'ikan gwaje-gwaje uku na sama shine cewa suna da sauƙin aiki kuma sun shahara sosai a cikin saitunan asibiti.Wannan binciken yana lura da ƙimar HbA1c, DD, da FIB na marasa lafiya tare da digiri daban-daban na DR, kuma yana kwatanta su da sakamakon marasa lafiya na DR DM da waɗanda ba DM ba, don bincika mahimmancin HbA1c, DD. da FIB.Ana amfani da gwajin FIB don saka idanu da abin da ya faru da ci gaban DR.
Wannan binciken ya zaɓi masu ciwon sukari na 61 (idanun 122) waɗanda aka yi musu jinya a sashen marasa lafiya na Baoding First Central Hospital daga Nuwamba 2017 zuwa Mayu 2019. Ma'auni na haɗawa da marasa lafiya sune: Masu ciwon sukari da aka gano bisa ga "Sharuɗɗa don Rigakafi da Jiyya na Nau'in 2 Ciwon sukari a China (2017)”, kuma ba a keɓance batutuwan gwajin lafiyar jiki don ciwon sukari.Sharuɗɗan cirewa sune kamar haka: (1) marasa lafiya masu ciki;(2) marasa lafiya da ciwon sukari;(3) marasa lafiya a ƙarƙashin shekaru 14;(4) akwai tasirin magunguna na musamman, kamar aikace-aikacen glucocorticoids na kwanan nan.Dangane da hotunan da ba na mydriatic fundus da sakamakon angiography na fluorescein, an raba mahalarta zuwa ƙungiyoyi uku masu zuwa: Ƙungiyar da ba DR (NDR) ta haɗa da marasa lafiya 23 (ido 46), maza 11, mata 12, da shekaru 43- shekara 76.Shekaru, matsakaicin shekaru 61.78 ± 6.28 shekaru;ƙungiyar DR (NPDR) ba ta haɓaka ba, lokuta 17 (ido 34), maza 10 da mata 7, 47-70 shekaru, matsakaicin shekaru 60.89 ± 4.27 shekaru;proliferative DR (Akwai lokuta 21 (ido 42) a cikin rukunin PDR, ciki har da maza 9 da mata 12, masu shekaru 51-73, tare da matsakaicin shekaru 62.24 ± 7.91 shekaru. Jimlar mutane 20 (ido 40) a cikin Ƙungiyar kulawa ba ta da kyau ga ciwon sukari, ciki har da maza 8 da mata 12, shekaru 50-75 shekaru, tare da matsakaicin shekaru 64.54 ± 3.11. Duk marasa lafiya ba su da cututtuka masu rikitarwa irin su cututtukan zuciya da cututtukan zuciya, da kuma raunin da ya faru a kwanan nan, tiyata, kamuwa da cuta, mugayen ciwace-ciwace ko wasu cututtukan na yau da kullun ba a cire su ba.Duk mahalarta sun ba da izini a rubuce don a haɗa su cikin binciken.
Majinyatan DR sun cika ka'idojin binciken da sashen kula da ido na sashen ido da kungiyar likitocin kasar Sin suka bayar.5 Mun yi amfani da kyamarar fundus maras-mydriatic (Canon CR-2, Tokyo, Japan) don yin rikodin sandar ta baya na asusun mai haƙuri.Kuma ya ɗauki hoto na 30°-45° fundus.Wani ƙwararren likitan ido ya ba da rahoton ganewar asali a rubuce bisa ga hotuna.A cikin yanayin DR, yi amfani da Heidelberg Retinal Angiography-2 (HRA-2) (Kamfanin Injiniya na Heidelberg, Jamus) don fundus angiography, kuma yi amfani da filin magani na farko na ciwon sukari na retinopathy (ETDRS) binciken angiography na Fluorescein (FA) don Tabbatar da NPDR ko PDR.Dangane da ko mahalarta sun nuna neovascularization na retinal, an raba mahalarta zuwa kungiyoyin NPDR da PDR.Wadanda ba DR masu ciwon sukari ba an lakafta su azaman ƙungiyar NDR;marasa lafiya da suka gwada rashin lafiya don ciwon sukari ana ɗaukar su azaman ƙungiyar kulawa.
Da safe, an tattara 1.8 ml na jini na venous na azumi kuma an sanya shi a cikin bututun rigakafin.Bayan sa'o'i 2, a hankali a hankali na minti 20 don gano matakin HbA1c.
Da safe, an tattara 1.8 ml na jinin azumi na venous, allura a cikin bututu anticoagulation, da centrifuged na 10 min.Daga nan kuma aka yi amfani da ma'aunin don gano DD da FIB.
Ana gudanar da ganowar HbA1c ta amfani da Beckman AU5821 na'urar tantance sinadarai ta atomatik da masu ba da tallafi.Ƙimar yankewar ciwon sukari> 6.20%, ƙimar al'ada shine 3.00% ~ 6.20%.
An yi gwajin DD da FIB ta amfani da STA Compact Max® mai nazarin coagulation ta atomatik (Stago, Faransa) da masu tallafawa reagents.Ma'anar ma'auni mai kyau shine DD> 0.5 mg / L da FIB> 4 g / L, yayin da dabi'u na al'ada sune DD ≤ 0.5 mg / L da FIB 2-4 g / L.
Ana amfani da shirin software na SPSS Statistics (v.11.5) don aiwatar da sakamakon;Ana bayyana bayanan azaman ma'anar ± daidaitaccen karkata (± s).Dangane da gwajin al'ada, bayanan da ke sama sun dace da rarraba na yau da kullun.An yi nazarin bambance-bambancen hanya ɗaya akan ƙungiyoyi huɗu na HbA1c, DD, da FIB.Bugu da ƙari, an ƙara kwatanta matakan ƙididdiga na DD da FIB;P <0.05 yana nuna cewa bambancin yana da mahimmancin ƙididdiga.
Shekaru na batutuwa a cikin ƙungiyar NDR, ƙungiyar NPDR, ƙungiyar PDR, da ƙungiyar kulawa sune 61.78 ± 6.28, 60.89 ± 4.27, 62.24 ± 7.91, da 64.54 ± 3.11 shekaru, bi da bi.An rarraba shekarun yawanci bayan gwajin rarraba na yau da kullun.Binciken bambance-bambancen guda ɗaya ya nuna cewa bambancin ba shi da mahimmancin ƙididdiga (P=0.157) (Table 1).
Table 1 Kwatanta na asali na asibiti da halayen ophthalmological tsakanin ƙungiyar kulawa da ƙungiyoyin NDR, NPDR da PDR
Matsakaicin HbA1c na ƙungiyar NDR, ƙungiyar NPDR, ƙungiyar PDR da ƙungiyar kulawa sune 6.58± 0.95%, 7.45± 1.21%, 8.04±1.81% da 4.53±0.41%, bi da bi.HbA1cs na waɗannan ƙungiyoyi huɗu ana rarraba su akai-akai kuma ana gwada su ta hanyar rarraba ta al'ada.Yin amfani da nazarin bambance-bambancen hanya ɗaya, bambancin ya kasance mai mahimmanci (P <0.001) (Table 2).Ƙarin kwatancen tsakanin ƙungiyoyi huɗu sun nuna manyan bambance-bambance tsakanin ƙungiyoyin (P <0.05) (Table 3).
Matsakaicin ƙimar DD a cikin ƙungiyar NDR, ƙungiyar NPDR, ƙungiyar PDR, da ƙungiyar kulawa sune 0.39 ± 0.21mg / L, 1.06 ± 0.54mg / L, 1.39 ± 0.59mg / L da 0.36 ± 0.17mg / L, bi da bi.Dukkan DDs ana rarraba su akai-akai kuma ana gwada su ta hanyar rarraba ta al'ada.Yin amfani da nazarin bambance-bambancen hanya ɗaya, bambancin ya kasance mai mahimmanci (P <0.001) (Table 2).Ta hanyar ƙarin kwatanta ƙungiyoyin huɗun, sakamakon ya nuna cewa ƙimar ƙungiyar NPDR da ƙungiyar PDR sun fi girma fiye da ƙungiyar NDR da ƙungiyar kulawa, kuma ƙimar ƙungiyar PDR tana da girma fiye da ƙungiyar NPDR. , yana nuna cewa bambanci tsakanin ƙungiyoyi yana da mahimmanci (P<0.05).Koyaya, bambanci tsakanin ƙungiyar NDR da ƙungiyar kulawa ba ta da mahimmanci (P> 0.05) (Table 3).
Matsakaicin FIB na ƙungiyar NDR, ƙungiyar NPDR, ƙungiyar PDR da ƙungiyar kulawa sune 3.07 ± 0.42 g / L, 4.38 ± 0.54 g / L, 4.46 ± 1.09 g / L da 2.97 ± 0.67 g / L, bi da bi.FIB na waɗannan ƙungiyoyi huɗu suna Nuna rarraba na yau da kullun tare da gwajin rarraba na yau da kullun.Yin amfani da nazarin bambance-bambancen hanya ɗaya, bambancin ya kasance mai mahimmanci (P <0.001) (Table 2).Ƙarin kwatanta tsakanin ƙungiyoyi huɗun ya nuna cewa ƙimar ƙungiyar NPDR da ƙungiyar PDR sun fi girma fiye da na ƙungiyar NDR da ƙungiyar kulawa, yana nuna cewa bambance-bambancen da ke tsakanin ƙungiyoyin suna da mahimmanci (P<0.05).Duk da haka, babu wani bambanci mai mahimmanci tsakanin ƙungiyar NPDR da ƙungiyar PDR, da NDR da ƙungiyar kulawa (P> 0.05) (Table 3).
A cikin 'yan shekarun nan, yawan ciwon sukari ya karu kowace shekara, kuma yawan DR ya karu.DR a halin yanzu shine mafi yawan sanadin makanta.6 Matsanancin hawan jini a cikin glucose na jini (BG)/sukari na iya haifar da yanayin jini na hypercoagulable, haifar da jerin rikice-rikice na jijiyoyin jini.7 Don haka, don lura da matakin BG da matsayin coagulation na masu ciwon sukari tare da haɓakar DR, masu bincike a kasar Sin da sauran wurare suna da sha'awar sosai.
Lokacin da haemoglobin da ke cikin jajayen ƙwayoyin jini suka haɗu da sukarin jini, ana samar da haemoglobin glycosylated, wanda yawanci yana nuna ikon sarrafa sukarin jini a cikin makonni 8-12 na farko.Samar da HbA1c yana sannu a hankali, amma da zarar an gama shi, ba a saurin karyewa;don haka, kasancewarsa yana taimakawa wajen lura da glucose na jini.8 Hyperglycemia na dogon lokaci na iya haifar da canje-canje na jijiyoyin jini maras canzawa, amma HbAlc har yanzu alama ce mai kyau na matakan glucose na jini a cikin masu ciwon sukari.9 matakin HbAlc ba wai kawai yana nuna abubuwan da ke cikin jini ba, har ma yana da alaƙa da matakin sukari na jini.Yana da alaƙa da rikice-rikice masu ciwon sukari irin su cututtukan microvascular da cututtukan macrovascular.10 A cikin wannan binciken, an kwatanta HbAlc na marasa lafiya da nau'ikan DR daban-daban.Sakamakon ya nuna cewa darajar kungiyar NPDR da PDR sun kasance mafi girma fiye da na kungiyar NDR da ƙungiyar kulawa, kuma darajar ƙungiyar PDR ta kasance mafi girma fiye da na kungiyar NPDR.Binciken da aka yi kwanan nan ya nuna cewa yayin da matakan HbA1c ya ci gaba da karuwa, yana rinjayar ikon haemoglobin don ɗaure da ɗaukar iskar oxygen, ta haka yana rinjayar aikin retinal.11 Ƙara matakan HbA1c yana da alaƙa da ƙara haɗarin rikice-rikice masu ciwon sukari, 12 da raguwar matakan HbA1c na iya rage haɗarin DR.13 An et al.14 sun gano cewa matakin HbA1c na marasa lafiya na DR ya fi girma fiye da na marasa lafiya na NDR.A cikin marasa lafiya na DR, musamman ma marasa lafiya na PDR, matakan BG da HbA1c suna da yawa, kuma yayin da matakan BG da HbA1c ke ƙaruwa, matakin nakasawar gani a cikin marasa lafiya yana ƙaruwa.15 Binciken da ke sama ya yi daidai da sakamakonmu.Duk da haka, matakan HbA1c suna shafar abubuwa kamar anemia, tsawon rayuwar haemoglobin, shekaru, ciki, jinsi, da dai sauransu, kuma ba zai iya nuna saurin canje-canje a cikin glucose na jini a cikin ɗan gajeren lokaci ba, kuma yana da "tasirin jinkiri".Don haka, wasu malaman sun yi imanin cewa darajar ambatonsa yana da iyaka.16
Siffofin cututtukan cututtuka na DR sune neovascularization na retinal da lalacewar shinge na jini-retinal;duk da haka, tsarin yadda ciwon sukari ke haifar da farkon DR yana da rikitarwa.A halin yanzu an yi imani da cewa lalacewar aikin tsoka mai santsi da sel na endothelial da kuma aikin fibrinolytic mara kyau na capillaries na retinal su ne ainihin abubuwan da ke haifar da cututtuka na marasa lafiya da ciwon sukari.17 Canjin aikin coagulation na iya zama alama mai mahimmanci don yin hukunci akan ciwon huhu.Ci gaban microangiopathy na ciwon sukari.A lokaci guda, DD wani takamaiman samfur ne na lalata fibrinolytic enzyme zuwa fibrin mai haɗin gwiwa, wanda zai iya sauri, sauƙi, da tsada-daidaita ƙimar DD a cikin jini.Dangane da waɗannan da sauran fa'idodi, yawanci ana yin gwajin DD.Wannan binciken ya gano cewa ƙungiyar NPDR da ƙungiyar PDR sun kasance mafi girma fiye da ƙungiyar NDR da ƙungiyar kulawa ta hanyar kwatanta matsakaicin darajar DD, kuma ƙungiyar PDR ta kasance mafi girma fiye da ƙungiyar NPDR.Wani bincike na kasar Sin ya nuna cewa aikin coagulation na masu ciwon sukari ba zai canza ba da farko;duk da haka, idan mai haƙuri yana da cututtukan ƙwayoyin cuta, aikin coagulation zai canza sosai.4 Yayin da matakin raguwar DR ya karu, matakin DD ya tashi a hankali kuma ya kai kololuwa a cikin marasa lafiya na PDR.18 Wannan binciken ya yi daidai da sakamakon binciken na yanzu.
Fibrinogen alama ce ta yanayin hypercoagulable da raguwar ayyukan fibrinolytic, kuma ƙarar matakinsa zai yi tasiri sosai ga coagulation na jini da ilimin jini.Abu ne mai mahimmanci na thrombosis, kuma FIB a cikin jinin masu ciwon sukari shine muhimmin tushe don samuwar yanayin hypercoagulable a cikin plasma na ciwon sukari.Kwatanta matsakaicin ƙimar FIB a cikin wannan binciken ya nuna cewa ƙimar ƙungiyoyin NPDR da PDR sun fi girma fiye da ƙimar NDR da ƙungiyoyin sarrafawa.Wani binciken ya gano cewa matakin FIB na marasa lafiya na DR ya fi na marasa lafiya na NDR, yana nuna cewa karuwar matakin FIB yana da wani tasiri akan faruwa da ci gaban DR kuma yana iya hanzarta ci gabansa;duk da haka, takamaiman hanyoyin da ke cikin wannan tsari ba su cika ba tukuna.bayyananne.19,20
Sakamakon da ke sama ya yi daidai da wannan binciken.Bugu da ƙari, binciken da ke da alaƙa ya nuna cewa haɗakar gano DD da FIB na iya sa ido da kuma lura da canje-canje a cikin yanayin hypercoagulable na jiki da kuma ilimin jini, wanda ya dace da ganewar asali, jiyya da kuma hangen nesa na nau'in ciwon sukari na 2 tare da ciwon sukari.Microangiopathy 21
Ya kamata a lura cewa akwai iyakoki da yawa a cikin bincike na yanzu wanda zai iya rinjayar sakamakon.Tun da yake wannan binciken ne na tsaka-tsaki, adadin marasa lafiya da ke shirye su yi amfani da ilimin ophthalmology da gwaje-gwajen jini a lokacin binciken yana iyakance.Bugu da ƙari, wasu marasa lafiya waɗanda ke buƙatar fundus fluorescein angiography suna buƙatar sarrafa hawan jini kuma dole ne su sami tarihin rashin lafiyan kafin gwajin.Ƙin duba ƙarin ya haifar da asarar mahalarta.Saboda haka, girman samfurin yana da ƙananan.Za mu ci gaba da fadada girman samfurin kallo a cikin karatu na gaba.Bugu da ƙari, ana yin gwajin ido ne kawai a matsayin ƙungiyoyi masu inganci;ba a yin ƙarin gwaje-gwaje na ƙididdigewa, kamar ma'auni na daidaitaccen gani na ma'auni na kauri ko gwajin hangen nesa.A ƙarshe, wannan binciken yana wakiltar ra'ayi mai ban sha'awa kuma ba zai iya nuna canje-canje a cikin tsarin cututtuka ba;karatu na gaba yana buƙatar ƙarin abubuwan lura.
A taƙaice, akwai bambance-bambance masu mahimmanci a cikin matakan HbA1c na jini, DD, da FIB a cikin marasa lafiya masu digiri daban-daban na DM.Matakan jini na ƙungiyoyin NPDR da PDR sun kasance mafi girma fiye da NDR da ƙungiyoyin euglycemic.Saboda haka, a cikin ganewar asali da kuma kula da masu ciwon sukari, haɗuwa da gano HbA1c, DD, da FIB na iya ƙara yawan ganowar lalacewar microvascular na farko a cikin masu ciwon sukari, sauƙaƙe ƙima na haɗarin rikice-rikice na microvascular, da kuma taimakawa farkon ganewar ciwon sukari. tare da retinopathy.
Kwamitin da'a na asibitin haɗin gwiwa na Jami'ar Hebei ya amince da wannan binciken (lambar amincewa: 2019063) kuma an gudanar da shi daidai da sanarwar Helsinki.An sami izinin rubutaccen bayani daga duk mahalarta.
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