Ischemic stroke is a disease that forms thrombosis and causes embolism. The imbalance of the blood coagulation system and the fibrinolytic system is one of the main causes of thrombosis. The four indicators of coagulation as important indicators for judging the changes in the body’s hemostasis system have received extensive clinical attention. Previous studies have shown that hyperglycemia is related to coagulation disorders , and patients with type 2 diabetes have vascular endothelial damage, which causes platelet activation and the hypercoagulable state of the blood . Therefore, in order to prevent further complications after stroke and type 2 diabetes, improve the quality of life of patients, and understand the blood coagulation status of stroke patients with type 2 diabetes, this study measures stroke. The levels of blood glucose, blood lipids and blood coagulation in patients with type 2 diabetes were observed to observe the changes of the 4 items of blood coagulation, and the clinical significance of the changes of the 4 items of blood coagulation in patients with increased blood sugar levels.
2. Materials and Methods
2.1. Clinical Data
Collect 134 stroke patients diagnosed and treated in the Affiliated Hospital of Qingdao University from 2018 to 2019. According to whether stroke patients have type 2 diabetes, they are divided into an observation group with type 2 diabetes (n = 62) and a control group without type 2 diabetes (n = 72), there was no difference in age between the two groups (65.88 ± 10.17 vs. 64.97 ± 8.61).
Inclusion criteria: 1) Patients meeting the diagnostic criteria for stroke; 2) Patients meeting the diagnostic criteria for type 2 diabetes
Exclusion criteria: 1) stroke patients with other diseases.
Laboratory testing: The subjects of each group were admitted to the hospital in the early morning on an empty stomach to collect peripheral venous blood. The laboratory of our hospital performed laboratory tests. The automatic biochemical analyzer (Hitachi-7600, Japan) measured four blood coagulation items in the two groups: coagulation Proenzyme time (PT), thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), blood glucose (GLU), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides (TG), cholesterol (CHOL).
2.3. Statistical Processing
SPSS21.0 statistical software was used for data processing. The comparison of means between groups was performed by t-test or rank-sum test. The correlation analysis was performed by preseason correlation analysis. P < 0.05 was considered statistically significant.
Comparing the four items of basic blood glucose, blood lipids and coagulation between the two groups of patients, only the blood glucose was significantly different (t = 6.17, P < 0.001), and there were no significant differences in other indicators (See Table 1 and Table 2).
Table 1. Comparison of blood glucose and blood lipids between the two groups (mmol/L).
Table 2. Comparison of four coagulation items between the two groups.
Table 3. Correlation analysis of four blood coagulation items with blood sugar and blood lipids.
*P < 0.05.
Figure 1. Correlation between PT and LDL (a) and CHOL (b).
A study of elderly patients with type 2 diabetes showed that PT and APTT were shorter than those in the healthy control group, and the PT and APTT of the complication group were lower than those of the non-complication group . Lin et al.  ’s study on patients with type 2 diabetes also showed that PT and APTT of type 2 diabetes patients with or without vascular complications decreased significantly, and the coagulation indexes PT, APTT, and TT of the group with vascular disease were significantly lower than those in the group without vascular disease. And the level of FIB increased significantly. Studies have shown that lipid metabolism disorders are an important reason for the increase. Abnormal glucose and lipid metabolism can easily damage endothelial cells and activate internal and exogenous blood coagulation pathways, leading to a significant increase in fibrinogen levels, and the increased fibrinogen makes blood sticky. Sex increases, blood flow slows down, making blood appear hypercoagulable state . However, in this study, the four indexes of prothrombin were not significantly different between the two groups of patients. Only PT was related to blood lipids, which may be related to the stroke disease itself. Chen et al.  showed that cerebral hemorrhage can affect blood glucose, the number of white blood cells and fibrinolysis to a certain extent, while platelets and related indicators have no significant changes, indicating that elevated blood glucose in the acute phase will lead to poor prognosis. The study found that the plasma thrombin cleavage fibrinopeptide A of the patients who were studied immediately after the stroke increased significantly, the plasma concentration of the platelet release product β-hemoglobin increased slightly, and immediately increased after the stroke, and these did not occur after the infarction. Over time, it was concluded that the activity of thrombin and plasmin in plasma increased after thrombotic stroke . Although there is evidence that increased fibrinogen concentration is associated with an increased risk of stroke, the role of abnormalities in the coagulation and fibrinolytic system in these processes has not been correctly assessed on clinical results. Smaller studies have found elevated FVIII/vWF associated with acute stroke and elevated tissue plasminogen activator levels. Although factor VII is considered a risk factor for coronary artery disease, little is known about its role in the development of cerebrovascular disease . Gentile et al.  showed that the changes in blood coagulation after acute ischemic stroke in patients with diabetes and hyperglycemia, compared with non-diabetic patients, acute ischemic stroke patients with diabetes and hyperglycemia have stronger procoagulant status. Diabetic cerebral infarction does have more serious coagulation dysfunction . Our study did not show that the four items of prothrombin between the two groups of patients were different, nor did it show that blood sugar had an effect on this. This may be that the acute effect of stroke is more than the chronic effect of diabetes, and the mechanism needs to be further developed in the study.
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