老年冠心病患者血清同型半胱氨酸与纤溶酶活性

背景同型半胱氨酸已成为动脉粥样硬化的独立危险因子,它可能通过破坏内皮细胞的结构和功能从而导致动脉粥样硬化.目的探讨同型半胱氨酸对老年冠心病患者纤溶酶活性的影响.设计以冠心病患者为研究对象,健康人群为对照组的病例-对照.单位一所大学医院的综合科及心内科.对象本研究于首都医科大学附属北京朝阳医院综合科及心内科完成.选择2001-12/2003-8本院心内科及综合科门诊及住院患者177例,根据冠状动脉造影结果分为冠心病组91例,其中男50例,女41例,平均年龄(66±6)岁;冠状动脉造影阴性组86例,其中男43例,女43例,平均年龄(60±6)岁.正常对照组为同期于本院门诊体检的健康中年人85例,其中男43例,女42例,平均年龄(55±5)岁.方法收集外周血,检测血浆中的组织型纤溶酶原激活剂、纤溶酶原激活物抑制剂1和血管性血友病因子的活性,用酶免疫试验法测同型半胱氨酸,并计算纤溶酶原激活物抑制剂1/组织型纤溶酶原激活剂活性比值.主要观察指标血清同型半胱氨酸水平及血浆组织型纤溶酶原激活剂、纤溶酶原激活物抑制剂1、血管性血友病因子活性,纤溶酶原激活物抑制剂1/组织型纤溶酶原激活剂的比值.结果冠状动脉病变组同型半胱氨酸,纤溶酶原激活物抑制剂1,纤溶酶原激活物抑制剂1/组织型纤溶酶原激活剂,血管性血友病因子均明显高于冠状动脉造影阴性组及正常对照组(P＜0.01),组织型纤溶酶原激活剂水平显著低于对照组(P＜0.01);从相关分析看,同型半胱氨酸与纤溶酶原激活物抑制剂1,纤溶酶原激活物抑制剂1/组织型纤溶酶原激活剂,血管性血友病因子呈正相关,与组织型纤溶酶原激活剂呈负相关.结论老年冠心病患者其血清同型半胱氨酸增高的同时,纤溶酶活性受损;同型半胱氨酸与纤溶酶原激活物抑制剂1,血管性血友病因子呈正相关,与组织型纤溶酶原激活剂呈负相关;同型半胱氨酸可能是冠状动脉早期病变的预报因子,可为冠心病的一级预防和早期康复措施介入提供相关实验数据.     

血浆纤溶功能对2型糖尿病血管病变的影响

目的：探讨2型糖尿病患者纤溶功能的改变及其对外周血管病变的影响，分析其纤溶功能紊乱的可能原因。方法：根据研究对象的临床表现及各种检查结果，分为4组。对照组23例，无并发症2型糖尿病组20例，微血管病变组20例，大血管病变组19例，采用酶联免疫吸附法测定其血浆纤溶酶-α2抗纤溶酶复合物、组织型纤溶酶原激活剂、纤溶酶原激活剂抑制物水平，同时测定其它一些临床生化指标。结果：无并发症2型糖尿病组、微血管病变组及大血管病变组与对照组比较血浆纤溶酶-α2抗纤溶酶复合物浓度显著增高（P〈0．01），凝血酶无时间缩短（P〈0．05）。微血管病变组、大血管病变组的纤溶酶原激活剂抑制物、组织型纤溶酶原激活剂、和纤维蛋白原高于对照组（P〈0．01）。大血管病变组纤溶酶原激活剂抑制物、APTT明显高于无并发症2型糖尿病组（分别为P〈0．01，P〈0．05），微血管病变组的纤维蛋白原高于无并发症2型糖尿病组（P〈0．01）。结论：2型糖尿病合并血管痛变者血浆纤溶酶-α2抗纤溶酶复合物、纤溶酶原激活剂抑制物、组织型纤溶酶原激活剂水平均升高，这种纤溶功能异常可能是糖尿病性血管病变形成的原因之一。     

弥散性血管内凝血患者血管内皮细胞标记物增加

作者测定了80例弥散性血管内凝血(DIC)、50例DIC前期和50例非DIC患者的血栓调节蛋白(TM)、血浆纤维蛋白溶酶原激活剂抑制物-1(PAI-1)、组织型纤维蛋白溶酶原激活剂(t-PA)及血管性假血友病因子(von Willebrand Factor,vWF)血管内皮细胞释放的标记物,同时还测定了血浆凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤维蛋白溶酶-α_2纤维蛋白溶酶抑制因子复合物(PIC)和FDP-D-二聚体     

糖耐量减低患者是否需要早期干预内皮相关因子异常与心血管疾病的危险性

目的探讨糖耐量减低患者是否具有与糖尿病患者相似的内皮相关因子异常,了解内皮相关因子与心血管疾病危险因素的关系.方法①选择2002-06/2003-05在首都医科大学附属北京同仁医院心血管中心门诊就诊和住院患者89例.设糖耐量减低者38例为糖耐量减低组,男21例,女17例.设明确除外冠心病的患者20例为单纯糖尿病组,男10例,女10例.设确诊为糖尿病合并冠心病患者31例为糖尿病合并冠心病组,男19例,女12例.选择同期本院进行健康体检健康者20人为对照组,男10人,女10人.均对检测项目均知情同意.②用酶联免疫吸附法检测血浆血管性假性血友病因子、凝血酶调节蛋白、纤溶酶原激活物抑制物1水平.③计量资料差异性测定采用单因素方差分析,q检验(方差齐时)及扩展了的t检验(方差不齐时).数据间相关性采用多元线性逐步回归检验.结果患者89例及健康者20人均进入结果分析.①血管性假性血友病因子糖耐量减低组和单纯糖尿病组及糖尿病合并冠心病组明显高于对照组(P＜0.01).②凝血酶调节蛋白水平糖耐量减低组、单纯糖尿病组、糖尿病合并冠心病组、对照组相近(P＞0.05).③纤溶酶原激活物抑制物1水平糖耐量减低组、单纯糖尿病组、糖尿病合并冠心病组明显高于对照组(P＜0.05～0.01);糖耐量减低组高于单纯糖尿病组的糖尿病合并冠心病组(P＜0.01).④相关性糖耐量减低组患者血管性假性血友病因子与C肽呈显著正相关(r=0.442,P＜0.05);纤溶酶原激活物抑制物1与饮酒史无明显相关性(r=0.469,P=0.07),与总胆固醇、病程呈显著正相关(r=0.659,0.766,P＜0.01).而糖尿病患者血管性假性血友病因子与病程呈显著正相关(r=0.316,P＜0.05);Ln(凝血酶调节蛋白)与糖化血红蛋白呈显著正相关(r=0.292,P=0.046);纤溶酶原激活物抑制物1与性别、血小板计数、凝血酶原时间、糖化血红蛋白呈显著正相关(r=0.447～0.86,P＜0.05～0.01).结论①糖耐量减低作为糖尿病的前驱阶段,已经存在内皮相关因子水平的异常,主要反映为血管性假性血友病因子、纤溶酶原激活物抑制物1水平异常.②糖耐量减低内皮相关因子异常与糖尿病相比在与病程相关方面具有相似性,这反映了糖耐量减低发展为糖尿病过程的某种连续性.③糖耐量减低患者与糖尿病、糖尿病合并冠心病患者内皮相关因子异常方面具有某些相似性,糖耐量减低患者可能与糖尿病具有相类似的致心血管疾病的危险性.     

糖耐量减低患者是否需要早期干预——内皮相关因子异常与心血管疾病的危险性

目的：探讨糖耐量减低患者是否具有与糖尿病患者相似的内皮相关因子异常,了解内皮相关因子与心血管疾病危险因素的关系.方法：①选择2002-06/2003-05在首都医科大学附属北京同仁医院心血管中心门诊就诊和住院患者89例.设糖耐量减低者38例为糖耐量减低组,男21例,女17例.设明确除外冠心病的患者20例为单纯糖尿病组,男10例,女10例.设确诊为糖尿病合并冠心病患者31例为糖尿病合并冠心病组,男19例,女12例.选择同期本院进行健康体检健康者20人为对照组,男10人,女10人.均对检测项目均知情同意.②用酶联免疫吸附法检测血浆血管性假性血友病因子、凝血酶调节蛋白、纤溶酶原激活物抑制物1水平.③计量资料差异性测定采用单因素方差分析,q检验（方差齐时）及扩展了的t检验（方差不齐时）.数据间相关性采用多元线性逐步回归检验.结果：患者89例及健康者20人均进入结果分析.①血管性假性血友病因子：糖耐量减低组和单纯糖尿病组及糖尿病合并冠心病组明显高于对照组（P＜0.01）.②凝血酶调节蛋白水平：糖耐量减低组、单纯糖尿病组、糖尿病合并冠心病组、对照组相近（P＞0.05）.③纤溶酶原激活物抑制物1水平：糖耐量减低组、单纯糖尿病组、糖尿病合并冠心病组明显高于对照组（P＜0.05～0.01）;糖耐量减低组高于单纯糖尿病组的糖尿病合并冠心病组（P＜0.01）.④相关性：糖耐量减低组患者血管性假性血友病因子与C肽呈显著正相关（r=0.442,P＜0.05）;纤溶酶原激活物抑制物1与饮酒史无明显相关性（r=0.469,P=0.07）,与总胆固醇、病程呈显著正相关（r=0.659,0.766,P＜0.01）.而糖尿病患者血管性假性血友病因子与病程呈显著正相关（r=0.316,P＜0.05）;Ln（凝血酶调节蛋白）与糖化血红蛋白呈显著正相关（r=0.292,P=0.046）;纤溶酶原激活物抑制物1与性别、血小板计数、凝血酶原时间、糖化血红蛋白呈显著正相关（r=0.447～0.86,P＜0.05～0.01）.结论：①糖耐量减低作为糖尿病的前驱阶段,已经存在内皮相关因子水平的异常,主要反映为血管性假性血友病因子、纤溶酶原激活物抑制物1水平异常.②糖耐量减低内皮相关因子异常与糖尿病相比在与病程相关方面具有相似性,这反映了糖耐量减低发展为糖尿病过程的某种连续性.③糖耐量减低患者与糖尿病、糖尿病合并冠心病患者内皮相关因子异常方面具有某些相似性,糖耐量减低患者可能与糖尿病具有相类似的致心血管疾病的危险性.     

心肌梗死患者血清血管紧张素转换酶与血浆纤溶酶原激活剂抑制物1的活性及其相关性

目的:测定心肌梗死患者及正常人血清血管紧张素转换酶、血浆纤溶酶原激活剂抑制物1水平,并通过其相关性分析探讨肾素-血管紧张素系统与纤溶之间的关系。方法:选择中山大学附属第二医院2002-12/2003-10收治的心肌梗死患者95例,以同期健康体检者87例为对照组。应用比色法测定两组受试者血清血管紧张素转换酶活性,同时应用发色底物法测定血浆纤溶酶原激活剂抑制物1水平,并对其结果进行直线相关性分析。结果:心肌梗死组93例、对照组87例进入结果分析。①心肌梗死组血清血管紧张素转换酶活性和血浆纤溶酶原激活剂抑制物1水平均高于对照组(3.60±0.97),(2.84±0.82)μkat/L;(0.85±0.19),(0.66±0.20)AU/mL,P均<0.01。②心肌梗死组与对照组血清血管紧张素转换酶、血浆纤溶酶原激活剂抑制物1水平均呈显著正相关(r=0.7108,0.7829,P均<0.01)。结论:①血清血管紧张素转换酶、血浆纤溶酶原激活剂抑制物1活性的增高与心肌梗死明显相关。②肾素-血管紧张素与纤溶之间存在一定的联系,血管紧张素转换酶可能通过影响血浆纤溶酶原激活剂抑制物1活性而参与对纤溶平衡的调节,两者之间的关系对冠状动脉粥样硬化性心脏病的发病起到重要作用。     

慢性阻塞性肺疾病患者血小板活化及纤溶功能的变化与炎症反应

目的:观察慢性阻塞性肺疾病患者急性发作期血液高凝状态的变化。方法:选择2003-01/2003-10上海市扬浦区中心医院呼吸内科住院慢性阻塞性肺疾病急性发作期患者30例为患者组,男20例,女10例。选择同期本院健康体检自愿者25名为对照组,男15名,女10名。均自愿参加。给予慢性阻塞性肺疾病急性发作期患者常规治疗。患者组在入院当天及病情稳定出院前取动脉血1mL作血气分析,包括氧分压、二氧分碳分压和血pH值。取静脉血1mL送检白细胞、中性粒细胞。采用酶联免疫吸附反应检测两组对象静脉血中P-选择素、D-二聚体、血管性血友病因子、组织纤溶酶原激活剂、纤溶酶原激活抑制物1的水平。结果:按意向处理分析,慢性阻塞性肺疾病急性发作期患者30例,健康人25人均进入结果分析。①检测动脉血P-选择素水平反映血小板活化程度:患者组治疗前后明显高于对照组(t=9.17,4.02,P<0.01),患者组治疗前明显高于治疗后(t=7.66,P<0.01)。②检测D-二聚体、血管性血友病因子水平反映血液是否处于高凝状态及内皮细胞功能:患者组治疗前明显高于对照组和治疗后(t=3.92～10.42,P<0.01)。③检测纤溶酶原激活抑制物1水平反映人体纤溶功能:患者组治疗前后明显高于对照组(t=8.59,8.69,P<0.01)。④检测组织纤溶酶原激活剂水平反映人体纤溶功能:患者组治疗前后明显低于对照组(t=18.33,18.42,P<0.01)。治疗后恢复不明显。⑤慢性阻塞性肺疾病急性期患者动脉血氧分压、二氧化碳分压、pH值、白细胞、中性粒细胞与血小板活化因子及纤溶功能的相关性:氧分压与纤溶酶原激活抑制物1、血管性血友病因子呈显著负相关(r=-0.364,-0.410,P<0.05);二氧化碳分压与D-二聚体呈显著正相关(r=0.442,P<0.05),与组织纤溶酶原激活剂呈显著负相关(r=-0.481,P<0.01);pH与P-选择素、纤溶酶原激活抑制物1、血管性血友病因子呈显著负相关(r=-0.367,-0.387,-0.404,P<0.05),与组织纤溶酶原激活剂呈正相关(r=0.659,P<0.01);白细胞、中性粒细胞均与P-选择素呈显著正相关(r=0.413,0.351,P<0.05)。结论:①P-选择素参与慢性阻塞性肺疾病急性发作期的炎症反应过程,急性发作期时血液处于高凝状态,血管内皮细胞受损,纤溶功能受损。②缺氧、酸碱失衡、炎症影响血小板功能。     

老年冠心病患者血清同型半胱氨酸与纤溶酶活性

背景：同型半胱氨酸已成为动脉粥样硬化的独立危险因子，它可能通过破坏内皮细胞的结构和功能从而导致动脉粥样硬化。目的：探讨同型半胱氨酸对老年冠心病患者纤溶酶活性的影响。设计：以冠心病患者为研究对象，健康人群为对照组的病例一对照。单位：一所大学医院的综合科及心内科。对象：本研究于首都医科大学附属北京朝阳医院综合科及心内科完成。选择2001—12／2003—8本院心内科及综合科门诊及住院患者177例，根据冠状动脉造影结果分为：冠心病组91例，其中男50例，女41例，平均年龄(66&;#177;6)岁；冠状动脉造影阴性组86例，其中男43例，女43例，平均年龄(60&;#177;6)岁。正常对照组为同期于本院门诊体检的健康中年人85例，其中男43例，女42例，平均年龄(55&;#177;5)岁。方法：收集外周血，检测血浆中的组织型纤溶酶原激活剂、纤溶酶原激活物抑制剂1和血管性血友病因子的活性，用酶免疫试验法测同型半胱氨酸，并计算纤溶酶原激活物抑制剂1／组织型纤溶酶原激活剂活性比值。主要观察指标：血清同型半胱氨酸水平及血浆组织型纤溶酶原激活剂、纤溶酶原激活物抑制剂1、血管性血友病因子活性，纤溶酶原激活物抑制剂1／组织型纤溶酶原激活剂的比值。结果：冠状动脉病变组同型半胱氨酸，纤溶酶原激活物抑制剂1，纤溶酶原激活物抑制剂1／组织型纤溶酶原激活剂，血管性血友病因子均明显高于冠状动脉造影阴性组及正常对照组(P&;lt;0．01)，组织型纤溶酶原激活剂水平显著低于对照组(P&;lt;0．01)；从相关分析看，同型半胱氨酸与纤溶酶原激活物抑制剂1，纤溶酶原激活物抑制剂1／组织型纤溶酶原激活剂，血管性血友病因子呈正相关，与组织型纤溶酶原激活剂呈负相关。结论：老年冠心病患者其血清同型半胱氨酸增高的同时，纤溶酶活性受损；同型半胱氨酸与纤溶酶原激活物抑制剂1，血管性血友病因子呈正相关，与组织型纤溶酶原激活剂呈负相关；同型半胱氨酸可能是冠状动脉早期病变的预报因子，可为冠心病的一级预防和早期康复措施介入提供相关实验数据。     

血栓前状态指标在缺血性脑血管病二级预防中的作用

目的:通过观察血栓前状态的实验室指标,探讨其对缺血性脑血管病二级预防的指导作用并评估小剂量肠溶阿司匹林等药物的干预效果。方法:选择2001-03/2004-08在甘肃省人民医院神经内科住院治疗的首次发病的急性脑梗死患者中筛选出存在血栓前状态的患者192例,随机分为干预组和对照组两组,每组96例。对照组给予常规治疗,干预组在对照组基础上每日早餐前(至少30min)口服肠溶阿司匹林50mg,同时给予维生素E、双嘧达莫、华法林等药物治疗。随访3年,每6个月复查1次血栓前状态的实验室指标(血浆血管性假血友病因子、P-选择素、D-二聚体、血浆纤维蛋白肽A、组织型纤溶酶原激活物极其抑制物),同时记录两组脑梗死患者复发及脑出血发生的例数。结果:按实际处理分析,进入结果分析170例,对照组87例,干预组83例。①观察3年中,对照组脑血栓形成复发率明显高于干预组[29%(28/96),10%(10/96),χ2=11.138,P<0.01];干预组的脑出血发生率与对照组比较无差异[4%(4/96),3%(3/96),χ2=0.148,P>0.05]。②血栓前状态的实验室指标结果:干预组经干预治疗后,血管性假血友病因子、P-选择素、D-二聚体、血浆纤维蛋白肽A水平减低,组织型纤溶酶原激活物活性增强,组织型纤溶酶原激活物抑制物活性减低,并且与对照组相比差异有显著性意义(P<0.01)。结论:血浆血管性假血友病因子、P-选择素、D-二聚体、血浆纤维蛋白肽A、组织型纤溶酶原激活物及其抑制物可作为诊断和监测血栓前状态的实验室指标;小剂量肠溶阿司匹林等药物能有效降低脑梗死的复发、同时不增加脑出血的发生率。     

急性有机磷农药中毒患者血浆血管性假性血友病因子、血小板颗粒膜蛋白、血浆纤溶酶原激活物及纤溶酶原激活抑制物活性的变化

急性有机磷农药中毒患者血浆血管性假性血友病因子、血小板颗粒膜蛋白、血浆纤溶酶原激活物及纤溶酶原激活抑制物活性的变化王钧薛重重杨丽萍范雅丽李智存吴雅锋李大钧１９９４年７月～１９９５年１０月，我们观察了３３例急性有机磷农药中毒患者血浆血管性假性血友病因子...     

Vascular endothelial markers, von Willebrand factor and thrombomodulin index, are specifically elevated in type 2 diabetic patients with nephropathy: comparison of primary renal disease

To elucidate the hypothesis that albuminuria in diabetic subjects reflects widespread vascular damage, plasma markers for vascular endothelial damage was measured in diabetic subjects with various degrees of albuminuria and compared to results in patients with primary renal disease. The groups consisted of 31 non-diabetic patient controls with normoalbuminuria, 109 type 2 diabetic patients with normo- micro- and macro-albuminuria, and 16 proteinuric patients with primary renal disease. Endothelial markers, plasma von Willebrand factor (vWF) and thrombomodulin (TM), were measured by enzyme-linked immunosolvent assay and enzyme immunoassay (EIA) methods, respectively. Plasma vWF levels were similar in controls (119+/-7%, mean+/-S.E.M.) and diabetic patients with normoalbuminuria (139+/-6), but significantly elevated in diabetic patients with microalbuminuria (174+/-11) and macroalbuminuria (204+/-17), while the level was not increased in patients with primary renal disease (124+/-11). Because plasma TM level was strongly affected by kidney function, TM index (TM (FU/ml)/serum creatinine (mg %)) was used as an endothelial marker. The TM index was substantially increased in diabetic patients with overt nephropathy compared with controls (5.29+/-2.98 vs. 2.35+/-0.85), whereas this was not observed in patients with primary renal disease (3.25+/-0.29). Both vWF and TM index were significantly higher in diabetic patients with retinopathy than in the patients without retinopathy. These results suggest that generalized vascular endothelial damage occurs in diabetic nephropathy including the microalbuminuric stage, which is not attributed to kidney damage per se.     

Measurement of soluble thrombomodulin in sera from various clinical stages of diabetic nephropathy

The levels of soluble thrombomodulin (TM) in serum samples were measured by one-step sandwich enzyme immunoassay. The aim of the present study was to determine if levels of soluble TM in sera might correlate with disease activity in patients with diabetic nephropathy. Three hundred and twenty patients with diabetic nephropathy were examined. Patients with diabetic retinopathy were excluded from the present study. This study showed an increase of soluble TM levels in sera from patients with diabetic nephropathy. The levels of soluble TM in sera from the macroalbuminuric stage with renal dysfunction were significantly increased compared with those from the normo-, micro-, or macroalbuminuric stage of diabetic nephropathy without renal dysfunction. The increase of soluble TM in sera paralleled levels of urinary albumin, blood urea nitrogen (BUN), s-creatinine (Cr), and duration of noninsulin-dependent diabetes mellitus (NIDDM). Furthermore, a decrease of TM staining in the glomerular capillary walls was observed in both microalbuminuric and macroalbuminuric stages by immunofluorescence. It appears that the measurement of soluble TM in sera is useful in evaluating the degree of glomerular endothelial injuries in patients with diabetic nephropathy. © 1996 Wiley-Liss, Inc.     

Increased thrombomodulin values in plasma of diabetic men with microangiopathy.

To study the significance of plasma thrombomodulin (TM) values in diabetes mellitus, we determined plasma TM in 34 patients with non-insulin-dependent diabetes mellitus (NIDDM) men, mean age 54 (SE 2) years. Plasma TM was determined by an enzyme immunoassay with anti-TM monoclonal antibodies. The plasma TM values were significantly greater in NIDDM patients with nephropathy than in patients without nephropathy (P less than 0.001). Also, a significant positive correlation was noted between the concentration of plasma TM and serum creatinine (r = 0.55, P less than 0.001). The plasma TM values of the patients with retinopathy were significantly greater than the values of those without it (P less than 0.002). Furthermore, we noted a significant positive correlation (r = 0.78, P less than 0.001) between plasma TM and the severity of diabetic retinopathy as graded by Scott's classification. These results suggest a close relationship between TM and diabetic microangiopathy.     

血浆chemerin水平与增殖型糖尿病视网膜病变相关

目的 探讨2型糖尿病患者血浆chemerin水平与糖尿病视网膜病变的相关性.方法 2型糖尿病患者200例,根据眼底镜或眼底荧光造影结果将其分为糖尿病对照组98例,非增殖型糖尿病视网膜病变组83例,增殖型糖尿病视网膜病变组19例.采用酶联免疫吸附测定法检测患者血chemerin水平,并采用Pearson相关分析法,分析患者血chemerin水平与患者年龄、体质量指数(BMI)、病程、血压、血脂、尿蛋白、超敏C 反应蛋白(hsCRP)等临床指标的相关性.结果 Chemerin在增殖型糖尿病视网膜病变组显著升高,并且chemerin水平与患者的糖尿病病程、胰岛素抵抗指数(HOMA-IR)、血hsCRP、尿白蛋白排泄量呈显著正相关.结论 Chemerin水平与增殖型视网膜病变相关,对糖尿病增殖型视网膜病变可能具有监测价值.     

Severe retinopathy in type 1 diabetic patients is not related to the level of plasma homocysteine

The vascular-injuring amino acid homocysteine was previously shown to be increased in plasma in type 1 diabetic patients with clinical signs of nephropathy. Previous studies have also shown an inconsistent relationship between the development of diabetic nephropathy and retinopathy, indicating different pathogenetic mechanisms. In this study, plasma homocysteine was measured in 25 type 1 diabetic patients with a well-characterized form of severe retinopathy. Furthermore, a group of 24 type 1 diabetic patients with similar age at onset of diabetes and diabetes duration with no or minimal background retinopathy were investigated, in order to determine whether plasma homocysteine levels are different from those in patients with severe retinopathy. Patients with severe retinopathy did not have higher plasma levels of homocysteine (13.9 micromol/L; 5.9-30.7, median and range) than those without retinopathy (10.4 micromol/L; 5.7-18.9). Within the group of patients with severe retinopathy, increased homocysteine levels were confined to the patients (19.9 micromol/L; 10.0-30.7, n=9) with serum creatinine levels > 100 micromol/L, compared to those patients (9.6; 5.9-14.3 micromol/L, n=15) with a serum creatinine below 100 micromol/L. None of the patients without or with minimal background retinopathy had serum creatinine levels > 100 micromol/L. We conclude that diabetic retinopathy is not associated with increased plasma homocysteine levels, but plasma homocysteine accumulates, probably owing to reduced glomerular filtration, in diabetic patients with signs of nephropathy. In these patients, the promoting effect of nephropathy on the development of retinopathy does not seem to be mediated through homocysteine.     

杏丁治疗对糖尿病肾病患者血浆血栓调节蛋白和血管性血友病因子的影响

目的：观察杏丁治疗对糖尿病肾病（DN）患者血浆血栓调节蛋白（TM）和血管性血友病因子（vWF）的影响。方法：60例DN患者，随机分为常规治疗组和杏丁治疗组。所有患者均于治疗前后抽血测TM、vWF、纤维蛋白原（FIB）、活化部分凝血活酶时间（APT）及血黏度。结果：杏丁治疗组患者治疗后。TM、vWF、FIB及血浆黏度均较治疗前显著下降（P〈0．01），全血黏度下降（P〈0．05），APTT显著延长（P〈0．01），且与常规治疗组相比较，差异有显著性（P〈0．05）。结论：DN患者体内存在内皮的损伤，高凝倾向。对DN患者早期使用杏丁治疗，可以有效地保护其血管内皮系统，改善其体内的高凝状态，对延缓疾病的进展有着重要意义。     

Is leptin associated with diabetic retinopathy?

OBJECTIVE: In advanced stages of diabetic retinopathy, new blood vessels are formed based on undefined mechanisms. Recently, leptin was shown to possess an angiogenic action in vitro and to induce neovascularization in vivo. The aim of the present study was to investigate the relationship between plasma leptin levels and the severity of diabetic retinopathy. RESEARCH DESIGN AND METHODS: There were 70 patients with type 2 diabetes (age 47.9 +/- 9.7 years, BMI 26.4 +/- 3.3 kg/m2) who were seen in a retina outpatient clinic recruited and assigned to subgroups according to the stage of their diabetic retinopathy. There were 66 healthy volunteer subjects matched with the diabetic patients for age, BMI, and sex who served as control subjects (age 46.0 +/- 8.8 years, BMI 27.1 +/- 2.3 kg/m2). Fasting plasma leptin levels were measured. RESULTS: Plasma leptin level of the diabetic patients was not significantly different from the control subjects. In patients with proliferative diabetic retinopathy (n = 17), the mean plasma level of leptin (16.1 +/- 9.2 ng/ml) was significantly higher than that in patients with nonproliferative retinopathy (n = 20) (11.5 +/- 3.5 ng/ml, P = 0.039) or patients without retinopathy (n = 33) (5.8 +/- 3.7 ng/ml, P = 0.001). The mean leptin level in patients with nonproliferative diabetic retinopathy was also significantly higher than that in patients without retinopathy (P = 0.002). CONCLUSIONS: Our results show that the more advanced the diabetic retinopathy, the higher the plasma leptin levels, even after adjusting the leptin levels for BMI. The presence of such a positive correlation need not imply a causal relationship. Nevertheless, previously observed leptin-induced promotion of angiogenesis and neovascularization lends support to the possibility that leptin may play a role in the progression of human diabetic retinopathy to a proliferative phase. This possibility deserves further investigation.     

C反应蛋白在糖尿病视网膜病变中的预测价值

目的 探讨C反应蛋白和糖化血红蛋白检测在糖尿病患者视网膜病变中的临床价值。方法 选取2012年3月至2013年10月该院内分泌科收治的2型糖尿病患者101例,根据患者视网膜病变并发情况,分为病变组（合并视网膜病变）42例和无病变组（未合并视网膜病变）59例,分别检测两组患者血清C反应蛋白水平。结果 病变组与无病变组患者血清C反应蛋白分别为（2．11±0．81）mg／L和（2．98±0．93）mg／L,病变组显著高于无病变组,差异有统计学意义（P〈0．05）,同时随着患者视网膜病变分级的升高,C反应蛋白水平依次升高。结论 糖尿病患者合并视网膜病变后血清C反应蛋白水平显著升高,并随着视网膜病变分期的升高而逐渐增强,提示C反应蛋白水平对2型糖尿病患者视网膜病变的严重程度具有一定的临床价值。     

住院糖尿病患者视网膜病变知识、态度、行为现状及相关因素分析

目的:调查住院糖尿病患者视网膜病变相关知识、态度、行为的现状,并分析影响因素。方法:本研究为横断面调查,采用糖尿病视网膜病变知识、态度、行为问卷、彩色眼底照相法,通过方便抽样,调查2018年12月—2019年6月某三级医院392例住院糖尿病患者的视网膜病变相关知识、态度、行为现状以及视网膜病变情况。结果:392例住院糖尿病患者中,267例有视网膜病变,其中需要治疗者123例。患者视网膜病变知识良好者20.9%(82/392),态度积极者10.5%(41/392),行为良好者7.9%(31/392)。多重回归分析结果显示,视网膜病变知识、态度、行为总分的相关因素为视网膜病变分期和糖尿病病程(P<0.01);知识的相关因素为性别、视网膜病变分期(P<0.01);态度的相关因素为糖尿病治疗方式、视网膜病变分组和糖尿病病程(P<0.01);行为的相关因素为视网膜病变分组(P<0.01)。结论:住院糖尿病患者视网膜病变知识、态度、行为良好率偏低,提示医务工作者应高度重视糖尿病视网膜病变的知识、态度、行为的提高,尤其应关注文化程度较低、家庭人均月收入不高、糖尿病病程较短和尚未发生重度视网膜病变的患者群,做到糖尿病知识的普及,改善患者糖尿病视网膜病变定期眼底检查态度,促进糖尿病视网膜病变良好眼底检查行为。     

Serum markers of oxidative stress and severity of diabetic retinopathy

OBJECTIVE: To compare serum markers of oxidative stress with diabetic retinopathy severity RESEARCH DESIGN AND METHODS: This cross-sectional study compared patients with types 1 and 2 diabetes with control subjects in western New York and Pennsylvania. Retinopathy severity was graded from funduscopic fields based on the Early Treatment of Diabetic Retinopathy Study. Serum samples were analyzed for thiobarbituric acid-reacting substances (TBARS), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities, creatinine, HbA1, and triglycerides. Appropriate analysis of covariance models were performed. RESULTS: TBARS (P = 0.019), triglyceride (P = 0.004), and glucose and HbA1 (both P<0.001) levels were elevated in diabetic patients compared with those in control subjects. SOD (P = 0.003) and GSH-Px (P = 0.046) levels were lower in diabetic patients than in control subjects. No correlation existed between SOD levels and either glucose or HbA1 levels. No significant associations existed between levels of TBARS, SOD, or GSH-Px and severity of diabetic retinopathy There was a significant association between poorer visual acuity and worse retinopathy (P = 0.009), which was only partly explained by macular edema. CONCLUSIONS: Increased levels of TBARS and decreased levels of SOD and GSH-Px were found in diabetic patients compared with those in control subjects, but no significant associations were found between the levels of these substances and severity of retinopathy When duration and type of diabetes and serum HbA1 levels were taken into account, only visual acuity remained associated with more severe retinopathy.