凝血、纤溶系统功能与2型糖尿病关系的研究

目的探讨机体凝血和纤溶系统功能的改变与2型糖尿病并发症的关系。方法选取49例2型糖尿病患者，按其24h内尿白蛋白量分为尿白蛋白正常组21例，微白蛋白尿组15例，临床肾病组7例，另为合并急性并发症组6例。同时选择30例年龄与患者相匹配的健康者作为对照组。测定血浆组织型纤溶酶原激活物（tPA）含量和纤溶酶原激活物抑制剂（PAI）含量、纤溶酶原（PLG）活性、D-二聚体（D-D）含量、凝血酶激活的纤溶抑制物（TAFI）含量及其活性（TAFIa）。结果糖尿病（DM）患者tPA为14．6±5．9μg/ml和PLG94．4±14．3％，皆明显低于对照组（两者分别为17．9±6．0μg/ml，101．4±11．7％；P〈0．05）；DM组PAI33．2±11．1μg/ml、D—D0．74±0．11μg／ml、TAFI 122．36±47．1％及TAFIa77．3±8．5μg/ml，显著高于对照组（分别是25．8±7．9、0．21±0．57、89．2±31．1、27．2±10．3），差异有显著性（均P〈0．05）；分析DM肾病患者白蛋白尿正常组与对照组差异无显著性，其余4组与对照组差异均有显著性（P〈0．05）。对TAFI相关分析，表明其与患者UAE、PAI、D—D结果呈正相关。结论机体凝血纤溶功能的异常改变与2型糖尿病肾病关系密切，各项目的检验，可反映糖尿病微血管病的程度，从而有助于临床对患者病情与预后的评估。

Study on the Relationship Between Blood Coagulation and Fibrinolysis Systems in Type 2 Diabetes Patients

Objective to study the relationship between blood coagulation And fibrinolysis system function in type 2 diabetes and with diabetic complication Patients . Methods 49 cases of type 2 diabetes mellitus（DM） were selected, according to their total excretions of urinary albumin in all day（24h, UAE）, they ere divided into three groups, that is 21 cases of normoalbuminuria group, 15 cases of microalbuminuria group, 7 cases of clinical diabetic nephropathy （macroalbuminuria） group. 6 cases of acute complication group were selected. Other 30 healthy persons were employed as control. The values or activities of plasma tissue- type plasminogen activator （ tPA）, plasminogen activator inhibitor （PAI）, plasminogen （ PLG）, D- di- mer（D-D） thrombin-activatable fibrinolysis inhibitor（TAFI） and its activated type （TAFIa） were measured in DM patients and control persons. Results Results reveal that tPA was 14.6 5.9 μg/ml and PLG was 94.4 14.3% in DM patients. Their values or activities were significantly lower than those of control group（ which were 17.9 6.0 μg/ml and 101.4 11.7% respectively, P 〈0.05）. The PAl was 33.2 11.1 μg/ml, D- D 0.74 ± 0.11 g/ml, TAFI 122.36±47.1% and TAFIa was 37.3 ±8.5 μg/ml, these results were significantly higher than those of control group respectively（of which those of control group were 25.8 ±7.9 μg/ml, 0.21 ±0.57 μg/ml, 89.2 ±31.1%, 27.2 ± 10.3 μg/ml respectively, （all P 〈0.05）. The studied results also showed that those of the albuminuria patient group and other acute complication eases in DM group, which were significantly different as compared with control group except the normoalbuminuria group. Furthermore, the TAFI level was positively correlative with UAE, PAI and D-D level. Conclusion The abnormality change of blood coagulation and fibrinolysis system is closely related to the damageof DM. These investigated could be reflected to the degree pathological changes of capillary vessel in DM.