凝血纤溶异常与早期糖尿病肾病的关系

目的:分析凝血纤溶异常在糖尿病肾病(DN)发生、发展中的作用,为早期诊断DN提供检测指标。方法:将90例2型糖尿病(DM)病人分为:无并发症组、正常白蛋白尿组(DMa组)、微量白蛋白尿组(DMb组)和临床蛋白尿组(DMc组)。测定其抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、凝血酶-抗凝血酶复合物(TAT)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活抑制物(PAI)等指标水平。结果:①无并发症组PAI、TAT、PC水平升高,AT-Ⅲ、t-PA活性降低,并随UAE增加而加重。②TAT、AT-Ⅲ水平在DMa、DMb、DMc组与无并发症组间,呈显著性差异(P<0.01),且DMc组TAT水平依次高于DMb组、DMa组(P<0.01);AT-Ⅲ水平DMc组依次低于DMb组、DMa组(P<0.01)。③PC、TAT、PAI与DM病程呈正相关。结论:DN患者早期即存在凝血功能亢进、纤溶活性低下,并随DN的进展而逐渐加重。

Relationship Between the Abnormality of Coagulation Fibrinolysis and Early Diabetic Nephropathy

Objective: To investigate the effects of abnormality of coagulation fibrinolysis on disease progression in diabetic nephropathy,providing parameters for early diagnosis of DN.Method: Ninety patients with type 2 diabetes mellitus (DM) were divided into non-complication group、normal Albuminuria group(DMa) 、microalbuminuria group(DMb) and proteinuria group (DMc). Measured the levels of AT-Ⅲ、PC、TAT、t-PA and PAI.Results: ①The levels of PAI、TAT、PC increased and the activities of AT-Ⅲ、t-PA decreased in non-complication group,which became more serious as UAE increased. ②The levels of TAT、AT-Ⅲ between DAa、DMb、DMc and non-complication group showed significant differences(P<0.01); level of TAT in DMc was significantly higher than that of DMb、DMa group(P<0.01); level of AT-Ⅲ in DMc successively was lower than that of DMb、DMa(P<0.01). ③PC、TAT、PAI were positively correlated with the course of disease. Conclusion: Early DN patients show hypercoagulation and impaired fibrinolytic activity,both of which become more serious with disease progress.