高血压患者胰岛素抵抗与纤溶系统的关系

目的研究高血压病(EH)患者胰岛素抵抗(IR)与纤溶系统的关系.方法 EH病人71例,采用75 g葡萄糖口服负荷法(OGTT),将EH患者分为糖耐量正常组(NGT)44例和糖耐量异常组(IGT)27例,正常对照组31例.测定血浆组织型纤溶酶原激活物活性(t-PA)、纤溶酶原激活物抑制物-1活性(PAI-1)、纤溶酶原活性(PLG),在OGTT测定的同时作血胰岛素(INS)测定,并根据Cederholm公式计算出胰岛素敏感指数(ISIc).结果 NGT组和IGI组相比t-PA无明显差别(P＞0.05),但两组均较正常对照组降低(P＜0.05).NGT组和IGT组PAI-1与正常对照组比较均无明显差别(P>0.05).IGT与NGT相比PLG增高(P＜0.05),与正常对照比较PLG明显增高(P＜0.01).ISIc在NGT组和IGT组较正常对照组明显降低(P＜0.05,P＜0.01),且IGT组较NGT组更低(P＜0.01).ISIc与t-PA, PAI-1不相关.结论高血压病人存在胰岛素抵抗,当高血压病合并IGT时,胰岛素抵抗更明显.EH病人存在纤溶活性的下降,当合并IGT时,纤溶活性的降低更为明显.t-PA和PAI-1与ISIc无明显相关性.     

缬沙坦治疗原发性高血压对内源性纤溶活性的影响

目的 :观察缬沙坦治疗原发性高血压 (EH)的同时对内源性纤溶活性的影响。方法 :用发色底物分解显色法测定 6 4例EH患者 (EH组 )和 35例正常对照者 (对照组 )的组织型纤溶酶原激活因子 (t PA)、纤溶酶原激活抑制物 (PAI 1)的活性 ,然后EH组口服缬沙坦 80mg ,每日 1次 ,共 8周 ,比较治疗前后的t PA和PAI 1活性变化。结果 :EH组治疗前t PA活性较对照组明显降低 ,PAI 1活性明显升高 (P <0 .0 5 )。经缬沙坦治疗 8周后 ,t PA活性较治疗前显著上升 ,PAI 1活性降低 (P <0 .0 5 )。结论 :缬沙坦在降低血压的同时 ,有改善内源性纤溶活性的作用。     

心力衰竭患者纤溶参数变化及药物干预效果的评价

目的 :了解风湿性心脏病和扩张型心肌病心力衰竭 (心衰 )患者纤溶参数的变化 ,并观察血管紧张素转换酶抑制剂和血管紧张素Ⅱ 1型受体拮抗剂对心衰患者纤溶参数的影响。　　方法 :测定 2 0例健康者 (正常对照组 )以及 2 9例风湿性心脏病和 3 1例扩张型心肌病心衰患者血浆组织型纤溶酶原激活物 (t PA)活性和纤溶酶原激活物抑制物 1(PAI 1)活性 ,随后 60例心衰患者被随机分为常规治疗组 ,常规治疗+福辛普利 (fosinopril) 10mg每日 1次 (福辛普利组 ) ,常规治疗 +氯沙坦 (losartan) 5 0mg每日 1次 (氯沙坦组 ) ,均为2 0例 ,治疗 14天后复测t PA和PAI 1活性。　　结果 :与正常对照组比较 ,风湿性心脏病和扩张型心肌病心衰患者纤溶参数异常 ,t PA活性下降 ,PAI 1活性升高 (P均 <0 0 1)。常规治疗组纤溶参数无显著变化 (P >0 0 5 ) ,福辛普利组和氯沙坦组纤溶参数明显改善 ,表现为t PA活性上升 ,PAI 1活性下降 (P均 <0 0 1) ,二者改善纤溶参数的效果相似 (P >0 0 5 )。　　结论 :风湿性心脏病和扩张型心肌病心衰纤溶参数明显异常 ,血管紧张素转换酶抑制剂和血管紧张素Ⅱ 1型受体拮抗剂能改善心衰患者纤溶参数。     

高血压患者胰岛素抵抗与凝血系统功能的关系

目的:研究高血压(EH)患者胰岛素抵抗(IR)与凝血系统功能的关系。方法:按75g葡萄糖口服负荷法(OGTT)结果,69例EH患者被分为糖耐量正常(NGT)组(43例)例和糖耐量异常(IGT)组(26例)。另正常对照组31例。测定各组纤维蛋白原(Pg)、纤溶酶原激活物抑制因子(PAI-1)含量,同时作血胰岛素(INS)测定, 用HOMA指数作为胰岛素抵抗指标。结果:高血压两组与正常对照组相比HOMA指数、Fg、PAI-1水平明显异常(P<0.05～<0.01).高血压IGT组的这些指标较高血压NGT组更恶化(P<0.05～<0.01)。HOMA与PAI-1、Fg 之间具有正相关性,其r分别为0.635,0.832。结论:高血压病人存在胰岛素抵抗和凝血异常,当高血压合并IGT时, 胰岛素抵抗更严重,血液促凝血状态加重。     

缺血性脑血管病纤溶活性和血清同型半胱氨酸含量测定的临床意义

目的　探讨缺血性脑血管病 (ICVD)患者血浆纤溶活性和血清同型半胱氨酸 (Hcy)含量的变化及其临床意义。方法　入选ICVD患者 86例 (ICVD组 ) ,根据病情又分为短暂脑缺血发作 (TIA)组 14例 ,脑梗死组 72例 ,并入选非脑血管病患者 4 3例作为对照组 ,分别采用产色法测定血浆纤溶酶原 (Plg)、组织型纤溶酶原激活物 (t PA)、纤溶酶原激活抑制物 1(PAI 1)活性 ,荧光偏振光法测定血清Hcy,电化学发光法测定叶酸 ,同时常规测定血脂水平。结果　ICVD组 ,TIA患者和脑梗死患者血浆Plg、t PA活性均较对照组显著降低 (P <0 .0 5 )。ICVD组血清Hcy水平较对照组明显升高 (P <0 .0 1) ,t PA活性降低和高Hcy对ICVD的发生均有显著作用。结论　t PA活性降低和高Hcy分别是ICVD的独立危险因素     

纤溶酶抗心绞痛作用与血浆纤维蛋白原及纤溶系统关系的研究

目的　探讨纤溶酶抗心绞痛与血浆纤维蛋白原 (Fib)含量及纤溶系统的关系。方法　对 3 0例难治性不稳定型心绞痛患者 ,常规抗心绞痛治疗的基础上 ,加用纤溶酶 2 0 0U加入生理盐水 2 5 0ml中 ,缓慢静脉滴注 ,每天 1次 ,连用 10天观察疗效及治疗前后血浆Fib、D 二聚体 (D D)含量、纤溶酶原激活物 (t PA)、纤溶酶原激活物抑制物I(PAI I)及心电图变化。结果　总有效率86% ,血浆Fib含量及PAI I活性较治疗前明显降低 (P <0 .0 1) ,D D含量及t PA活性明显增高(P <0 .0 1) ,心电图NST及∑ST较治疗前明显改善 (P <0 .0 1)。结论　纤溶酶抗心绞痛通过降纤溶栓调节纤溶系统来完成     

经皮腔内冠状动脉成形术和(或)冠状动脉支架术后纤溶的变化

目的 :认识经皮腔内冠状动脉成形术 (PTCA)和 (或 )冠状动脉支架术 (Stent)后纤溶功能的变化特点 ,探讨其变化对近期治疗结果的影响。方法 :纤溶指标包括纤溶酶原 (PLG)、组织型纤溶酶原活化剂 (t PA)、纤溶酶原活化物抑制剂 (PAI)。在常规使用抗血小板药与抗凝剂的情况下 ,比较 71例患者PTCA和 (或 )Stent后16h及 1周与术前PLG、t PA及PAI的变化。观察术后是否存在冠状动脉血栓形成的情况。结果 :纤溶功能术后 16h明显增强 ,1周时基本恢复。未见术后冠状动脉血栓形成的患者。结论 :术后短时间内纤溶活性明显增强有利于避免冠状动脉内血栓形成。     

氯沙坦对高血压病患者尿白蛋白及纤溶活性的影响

目的　探讨尿白蛋白排泄率与纤溶活性的关系及氯沙坦对其影响。方法　选择 6 2例高血压病伴轻、中度肾功能损害 (肌酐清除率 <70mL/min ,但≥ 30mL/min)患者 ,经随机分为两组分别予氯沙坦 5 0～ 10 0mg/d或卡托普利75～ 15 0mg/d降压治疗 12周。同时选择 2 4例高血压病伴肾功能完全正常 (肌酐清除率≥ 80mL/min)患者作为对照组 ,降压治疗前后分别测定尿白蛋白排泄率 (UAE)、纤溶酶原激活剂活性 (tPA)、纤溶酶原激活抑制剂活性 (PAI)。结果　肾功能异常组UAE、PAI均升高 (P <0 0 1) ,tPA降低 (P <0 0 5 ) ;UAE与tPA ,PAI,PAI/tPA相关系数分别为 0 2 0 (P >0 1)、0 32 (P <0 0 5 )、0 34(P <0 0 1) ,UAE与纤溶活性降低正相关 ;降压治疗后两组均降低UAE、PAI(P <0 0 1) ,卡托普利组还升高tPA(P <0 0 5 )。结论　肾功能异常时纤溶活性降低 ,肾功能损害与纤溶降低有关 ,氯沙坦及卡托普利改善肾功能 ,也改善纤溶活性。     

索他洛尔对急性心肌梗死血小板活化及纤溶活性和内皮血管活性物质的影响

目的 :探讨索他洛尔对急性心肌梗死 (AMI)血小板活化、纤溶活性和内皮血管活性物质的影响。方法 :新西兰大白兔 4 0只 ,随机分为 4组 ,每组 10只 ,Ⅰ组 :假手术组 ,Ⅱ组 :AMI组 ,Ⅲ组 :利多卡因组 ,Ⅳ组 :索他洛尔组 ;Ⅱ、Ⅲ、Ⅳ组分别结扎冠状动脉左室支中点 ,4h后取血分别测定血栓素B2 (TxB2 )、6 酮 前列腺素F1α(6 keto PGF1α)、内皮素 (ET)、一氧化氮 (NO)浓度和组织型纤溶酶原激活剂 (t PA)、纤溶酶原激活剂抑制物 (PAI)活性 ;摘取心脏 ,测定心肌梗死范围。结果 :Ⅱ、Ⅲ、Ⅳ组与Ⅰ组比较 ,血浆TxB2 、ET、NO浓度和PAI活性显著升高(P <0 .0 1) ,6 keto PGF1α浓度、t PA活性显著下降 (P <0 .0 1) ,Ⅲ组与Ⅱ组比较 ,差异无显著性意义 ,Ⅳ组与Ⅱ组比较 ,血浆TxB2 、ET、NO浓度和PAI活性明显降低 (P <0 .0 1) ,6 keto PGF1α浓度、t PA活性显著升高 (P <0 .0 1) ,梗死范围减小。结论 :索他洛尔抑制AMI早期血小板活化 ,改善纤溶活性 ,减少ET和NO的释放 ,缩小心肌梗死范围     

阿托伐他汀对原发性高血压患者血压及内源性纤溶活性的影响

目的　通过对阿托伐他汀调脂同时对原发性高血压 (EH)患者血压及内源性纤溶活性影响的观察 ,探讨其非调脂作用。方法　观察 4 2例 1级原发性高血压患者 ,口服阿托伐他汀 10mg ,2 /d ,8周 ,分别对患者治疗前及治疗后进行血压、血清总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL -C)、高密度脂蛋白胆固醇 (HDL -C)、分泌组织性纤溶酶原激活因子 (t-PA)和纤溶酶原激活抑制因子 (PAI - 1)检测。结果　与正常对照组比较 ,EH组治疗 8周后收缩压均有显著降低 (P <0 .0 5 ) ,t-PA活性明显升高 (P <0 .0 1) ,PAI - 1活性明显降低 (P <0 .0 5 ) ,EH并血脂紊乱 (EHA)组治疗后TC、TG、LDL -C较治疗前均显著降低 (P <0 .0 1) ,HDL -C明显升高 (P <0 .0 5 )。结论　阿托伐他汀在有效调脂同时可发挥其非调脂作用 ,能降低EH患者血压及改善内源性纤溶活性     

Acute hyperglycemia alters von Willebrand factor but not the fibrinolytic system in elderly subjects with normal or impaired glucose tolerance.

To assess whether acute hyperglycemia affects fibrinolytic balance in elderly subjects with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT), 40 non-obese elderly subjects (20 NGT, age 68 +/- 8 years; and 20 IGT, age 69 +/- 11 years) were studied. On two experimental days, randomly allocated and spaced 1 week apart, plasma concentrations of glucose, insulin, fibrinogen, tissue plasminogen activator, plasminogen activator inhibitor type 1 and von Willebrand factor (vWF) were measured in each subject at baseline (0) and 30, 60, 90, 120 min after the ingestion of 75 g glucose or a similarly sweet dose of aspartame (250 mg) (control test). In both NGT and IGT elderly subjects, tissue plasminogen activator, plasminogen activator inhibitor type 1 and fibrinogen plasma levels did not significantly change after both oral aspartame and glucose load. In IGT subjects, vWF plasmatic levels decreased after glucose (not aspartame) oral load, reaching the minimum level at 90 min after load (82.7 +/- 7.8 versus 93.7 +/- 10.2, P <0.01). These results demonstrate that acute hyperglycemia does not modify plasma fibrinolysis in elderly subjects. The decrease of plasma concentration of vWF in IGT elderly subjects requires cautious interpretation and further extensive investigations.     

Glucagon as a determinant of fibrinolytic activity in men with different stages of glucose tolerance: impact of glucagon on fibrinolysis.

Glucagon plays an important role in postprandial hyperglycemia in type 2 diabetes (T2DM), and coexists with insulin resistance and impaired fibrinolysis. We analyzed the response of plasminogen activator inhibitor-1 (PAI-1) to a lipid-glucose-protein test and the relationship between glucagon and PAI-1, tissue plasminogen activator (t-PA) and PAI-1/t-PA in 26 men with normal glucose tolerance (NGT), nine with impaired glucose tolerance (IGT) and 12 with T2DM. Fasting and postprandial PAI-1 were higher in T2DM versus NGT (P < 0.05). In univariate analysis in NGT, fasting and area under the curve (AUC) PAI-1 showed a strong relationship with fasting (P = 0.003, P = 0.006) and postprandial (P = 0.041, P = 0.045) glucagon, t-PA with fasting glucagon (P = 0.014), and PAI-1/t-PA with fasting (P = 0.047) and AUC glucagon (P = 0.017). In IGT fasting, AUC PAI-1 and PAI-1/t-PA were associated with AUC glucagon (P = 0.035, P = 0.032, P = 0.023). In NGT with the fasting metabolic parameters and insulin resistance as independent variables, fasting glucagon remained an independent covariate for PAI-1 and PAI-1/t-PA. In another model, postprandial glucagon was independently associated with PAI-1/t-PA in NGT (P < 0.05). Besides the already established determinants, we found an independent association between glucagon and fibrinolysis in NGT. Further studies are needed to identify the link between glucagon, insulin resistance and hemostasis.     

糖耐量低减患者动态血压的改变

为观察糖耐量低减（ＩＧＴ）患者动态血压（ＡＢＰＭ）的改变，对血压正常和血压增高的ＩＧＴ患者各２０例进行２４小时ＡＢＰＭ监测及各项生化指标检查，并设有糖耐量正常组和糖尿病组进行对照研究。结果ＩＧＴ患者２４小时ＡＢＰＭ的变化与糖耐量正常者相似，但具有夜间血压增高和昼夜血压差值减小的趋势。血压昼夜节律异常的ＩＧＴ患者ＡＢＰＭ的改变为夜间血压升高。表明ＩＧＴ患者已开始出现早期的血压改变。     

不同糖耐量人群血浆脂肪酸谱与胰岛素抵抗

目的　研究不同糖耐量人群血浆脂肪酸谱与胰岛素抵抗 (IR)之间的关系。方法　将受试者根据口服葡萄糖耐量试验 (OGTT)结果分为正常糖耐量组 (NGT) ,糖耐量受损组 (IGT )及 2型糖尿病组(DM )。采用毛细血管气相色谱法测定血浆脂肪酸谱 ,用胰岛素敏感指数 (IAI)评估IR。结果　DM组及IGT组血浆软脂酸 (C16:0 )、硬脂酸 (C18:0 )、二十二烷酸 (C2 2 :0 )、二十四烷酸 (C2 4:0 )和饱和脂肪酸浓度较NGT组明显升高 (P <0 .0 5～P <0 .0 1) ;花生四烯酸 (C2 0 :4)分别从NGT、IGT和DM组依次升高 ,差异有显著性 (P <0 .0 5～P <0 .0 1) ;血浆饱和脂肪酸 (SFA)从NGT、IGT、DM亚组依次升高 (P <0 .0 5～P <0 .0 1) ;NGT组的多不饱和脂肪酸 (PUFA)与饱和脂肪酸 (SFA)的比率高于IGT组和DM组 (均P <0 .0 5 ) ;血浆C16:0、C2 0 :4、C2 2 :0、SFA与IAI呈负相关 (P均 <0 .0 1)、PUFA/SFA与IAI呈正相关 (P <0 .0 1)。结论　不同糖耐量者血浆脂肪酸谱不同 ,糖耐量减低与 2型糖尿病患者SFA浓度升高 ,PUFA/SFA下降 ,且与胰岛素抵抗密切相关     

高血压患者糖耐量与超敏C反应蛋白的相关性

目的通过对不同糖耐量水平的原发性高血压患者的血浆超敏C反应蛋白(hsCRP)水平进行比较,探讨hsCRP与原发性高血压患者糖耐量水平的相关性。方法按条件入选原发性高血压患者146例,行葡萄糖耐量试验(OGTT)、血脂及hsCRP检测,根据糖耐量水平分为3组:糖耐量正常(NGT)组、糖耐量异常(IGT)组和2型糖尿病(T2DM)组。结果(1)3组患者之间在年龄、性别、体重、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、低密度脂蛋白胆固醇(LDL-C)及甘油三酯(TG)等指标上均无显著性的统计学差异,具有较好的可比性;(2)3组患者之间的hsCRP水平逐渐升高,组间比较有明显差异性(P<0·01)。原发性高血压患者糖耐量越差则血浆hsCRP水平越高(r=0·72,P<0.05)。结论对伴有hsCRP升高的原发性高血压患者行OGTT检查可早期发现糖耐量异常,及时给予针对性干预治疗。     

空腹血糖异常、糖耐量减低患者血清胰岛素水平的变化及其意义

目的 观察空腹血糖异常(IFG)、糖耐量减低(IGT)患者血清胰岛素水平的变化。方法 对50例空腹血糖和糖耐量正常者(NGT)、40例IFC和80例IGT患者行口服葡萄糖耐量试验(0GTT)，用氧化酶法检测血糖，用放免法测定血清空腹及餐后2小时胰岛素。结果 IFG、IGT组空腹血糖、空腹胰岛素水平及胰岛素敏感指数较NGT组明显升高(P＜0.05或P＜0．01)，IFG组胰岛素敏感指数与IGT组比较无显著性差异(P＞0．05)。结论 在IFG、IGT状态下已经存在胰岛素抵抗，而且在程度上两者间并没有显著性差异，应早期干预治疗。     

Effects of mealtime insulin aspart and bedtime neutral protamine Hagedorn insulin on postprandial coagulation and fibrinolysis in patients with type 2 diabetes

Aim: Acute hyperglycaemia induces coagulation activation in diabetes patients. We hypothesized that rapid‐acting insulin has a beneficial postprandial effect on coagulation and fibrinolysis compared with intermediate‐acting insulin because of its ability to lower postprandial hyperglycaemia. Methods: This was tested in a parallel controlled study in well‐controlled patients with type 2 diabetes assigned to bedtime neutral protamine Hagedorn (NPH) insulin (n = 41) or mealtime insulin aspart (n = 37). They were served standard diabetic meals for breakfast (8:00 hours) and lunch (12:00 hours). Blood samples were collected at 7:40 hours (fasting), 9:30, 11:30, 13:30 and 15:30 hours and analysed for glucose, activated factor VII (FVIIa), D‐dimer, prothrombin fragment 1+2 (F1+2), tissue plasminogen activator antigen (t‐PA) and plasminogen activator inhibitor activity (PAI). Results: The postprandial glucose response differed significantly between insulin regimens with a postprandial increase on NPH insulin and a decrease on insulin aspart. There was a significant postprandial decrease in F1+2, PAI and t‐PA, and no changes in FVIIa and D‐dimer, on both insulin regimens, but with no differences between insulin treatment groups. Conclusions: The rapid‐acting insulin analogue aspart and the intermediate‐acting insulin NPH had similar postprandial effects on markers of coagulation activation and fibrinolysis despite different effects on postprandial glucose response.     

Pancreatic polypeptide response to oral glucose load in patients with liver cirrhosis--interrelationship between PP and other pancreatic endocrine hormones

The purpose of the present study was to elucidate the interrelationship between pancreatic polypeptide (PP) and other pancreatic endocrine hormones. For this purpose, a radioimmunoassay (RIA) system of plasma PP was established and the changes in plasma PP, plasma immunoreactive insulin (IRI), plasma C-peptide reactivity (CPR) and plasma immunoreactive glucagon (IRG) following oral administration of glucose were examined in ten normal subjects and twenty-five patients with liver cirrhosis. Patients with liver cirrhosis were classified into a normal glucose tolerance group (NGT), an impaired glucose tolerance group (IGT), and a diabetes mellitus group (DM) on the basis of the glucose tolerance curves obtained after the oral administration of glucose. In the IGT and DM groups, fasting plasma PP levels were significantly elevated when compared with those in the control and NGT groups. Also oral administration of 75g glucose elicited an exaggerated rise in plasma PP in the IGT and DM groups when compared with the response in the control and NGT groups. On the other hand, PP response to glucose in the NGT group was similar to that in the control group. Plasma IRI increased markedly before and after oral administration of glucose in the IGT and DM groups when compared with the control groups. In these patients, plasma levels of CPR almost paralleled those of IRI. No significant difference was noted between the NGT group and the control group with regard to plasma IRI and CPR levels before and after oral glucose loading. Accordingly, insufficient insulin action was considered to exist in the IGT and DM groups. This insufficiency in insulin action was expressed in terms of the indices of increase in plasma IRI and CPR, delta IRI/delta BS and delta CPR/delta BS, which corresponded to the elevated blood glucose levels, being significantly lower in the IGT and DM groups than in the control and NGT groups 30 minutes after oral administration of glucose. No significant difference was noticeable between the NGT group and control group with regard to these indices. In the patients with liver cirrhosis, the delta PP value, obtained by subtracting the plasma PP level during fasting from the PP level 30 minutes after oral glucose loading, was inversely correlated with the values of both delta IRI/delta BS and delta CPR/delta BS.(ABSTRACT TRUNCATED AT 400 WORDS)     

冠心病患者胰岛素抵抗与纤溶系统活性的关系

目的 观察冠心病患者胰岛素抵抗及与纤溶系统活性的关系?方法及结果 37例冠心病患者的胰岛素敏感性指数(ISI)绝对值、纤溶酶原激活物抑制因-子-1(PAI-1)活性和纤溶酶原(PLg)含量升高,组织型纤溶酶原激活物(t-PA)活性及纤溶酶(PL)活性降低：ISI绝对值与PLg含量、PM-1活性均呈正相关,与t-PA活性呈负相关;结论 冠心痛患者的纤溶系统活性异常与胰岛素抵抗有关。