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粘弹性作为控制不佳的2型糖尿病患者血凝块结构的一种测量方法:迈向精准和个性化医疗方法

Viscoelasticity as a measurement of clot structure in poorly controlled type 2 diabetes patients: towards a precision and personalized medicine approach.

作者信息

Pretorius Etheresia, Bester Janette

机构信息

Department of Physiology, University of Pretoria, Pretoria, South Africa.

出版信息

Oncotarget. 2016 Aug 9;7(32):50895-50907. doi: 10.18632/oncotarget.10618.

Abstract

OBJECTIVES

Type 2 diabetes patients (T2D) have a considerably higher cardiovascular risk, which is closely associated with systemic inflammation, and an accompanying pathologic coagulation system. Due to the complexity of the diabetic profile, we suggest that we need to look at each patient individually and particularly at his or her clotting profile; as the healthiness of the coagulation system gives us an indication of the success of clinical intervention.

RESULTS

T2D coagulability varied markedly, although there were no clear difference in medication use and the standards of HbA1c levels.

RESEARCH DESIGN AND METHODS

Our sample consisted of 90 poorly controlled T2D and 71 healthy individuals. We investigated the medication use and standards of HbA1c levels of T2D and we used thromboelastography (TEG) and scanning electron microscopy (SEM) to study their clot formation.

CONCLUSION

The latest NIH guidelines suggest that clinical medicine should focus on precision medicine, and the current broad understanding is that precision medicine may in future, provide personalized targets for preventative and therapeutic interventions. Here we suggest a practical example where TEG can be used as an easily accessible point-of-care tool to establish a comprehensive clotting profile analysis for T2D patients; and additionally may provide valuable information that may be used in the envisaged precision medicine approach. Only by closely following each individual patient's progress and healthiness and thereby managing systemic inflammation, will we be able to reduce this pandemic.

摘要

目的

2型糖尿病患者(T2D)具有显著更高的心血管风险,这与全身炎症及伴随的病理性凝血系统密切相关。由于糖尿病病情的复杂性,我们建议需要对每位患者进行个体化评估,尤其要关注其凝血状况;因为凝血系统的健康状况能为临床干预的成功与否提供线索。

结果

尽管在用药情况和糖化血红蛋白(HbA1c)水平标准方面没有明显差异,但T2D患者的凝血能力差异显著。

研究设计与方法

我们的样本包括90例血糖控制不佳的T2D患者和71名健康个体。我们调查了T2D患者的用药情况和HbA1c水平标准,并使用血栓弹力图(TEG)和扫描电子显微镜(SEM)来研究他们的血栓形成情况。

结论

美国国立卫生研究院(NIH)的最新指南建议临床医学应关注精准医学,目前的普遍认识是精准医学未来可能会为预防和治疗干预提供个性化靶点。在此,我们提出一个实际例子,即TEG可作为一种易于获取的床旁检测工具,为T2D患者建立全面的凝血状况分析;此外,它还可能提供有价值的信息,可用于设想中的精准医学方法。只有密切关注每位患者的病情进展和健康状况,进而控制全身炎症,我们才能减少这种流行病的发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1ac/5239445/4572b050e62a/oncotarget-07-50895-g001.jpg

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