糖尿病患者血小板膜糖蛋白的改变及其临床意义

目的观察Ⅱ型糖尿病患者血小板膜糖蛋白的变化及其临床意义。方法应用流式细胞术（ＦＣＭ）观察７０例Ⅱ型糖尿病患者及２８名正常人血小板膜上ＧＰⅠｂ、Ⅱｂ、Ⅲａ及Ｐ选择素的表达。以免疫放射法（ＩＲＭＡ）测定血小板膜Ｐ选择素分子数，并以酶联免疫法（ＥＬＩＳＡ）对血浆中的Ｐ选择素进行检测。结果ＦＣＭ测得的血小板膜上Ｐ选择素表达阳性率，糖尿病伴血管病患者为（１０．２８±４．８６）％，明显高于正常人的（３．７５±１．８３）％（Ｐ＜０．０１）及无血管病变者的（４．２５±２．２９）％（Ｐ＜００１）。用ＩＲＭＡ法测得的结果与ＦＣＭ类似。血浆中Ｐ选择素浓度伴血管病变组（６．１８±３．２０）μｇ／Ｌ亦高于正常对照组的（３．４３±１．５６）μｇ／Ｌ（Ｐ＜０．０５）及无血管病变组的（３．７１±２．１２）μｇ／Ｌ（Ｐ＜００５）。相反，血小板上ＧＰⅠｂ的表达在糖尿病伴血管病变组为（８６．３５±１１．００）％明显低于正常对照组的（９２６３±７．５５）％（Ｐ＜０．０５）。而血小板ＧＰⅡｂ、Ⅲａ的表达无改变。结论有血管病变的Ⅱ型糖尿患者血小板膜上和血浆中Ｐ选择素升高，而ＧＰⅠｂ降低。

Alterations of platelet membrane glycoproteins in patients with diabetes mellitus and their clinical significance

OBJECTIVE: To investigate changes of platelet glycoproteins in patients with diabetes mellitus(DM) type II and their clinical significance. METHODS: Seventy DM patients and 28 normal individuals entered in this study. The platelet glycoproteins Ib, IIb, IIIa and P-selectin were analyzed by flow cytometry (FCM). Platelet surface P-selectin was measured by Immunoradiometric analysis (IRMA), and plasma P-selectin concentration by ELISA. RESULTS: On FCM, the P-selectin expression on platelets of patients with vascular diseases (10.28 +/- 4.86)%] was higher than that of normal subjects (3.75 +/- 1.83)%] (P < 0.01) and patients without vascular diseases (4.25 +/- 2.29)%] (P < 0.01). Similar results were obtained using IRMA. Plasma P-selectin concentration in patients with vascular diseases (6.18 +/- 3.20) ng/ml] was higher than that of control group (3.43 +/- 1.56) ng/ml](P < 0.05) and that of patients without vascular diseases (3.71 +/- 2.12) ng/ml] (P < 0.05). On the contrary, the platelet surface GP Ib expression in patients with vascular diseases (86.35 +/- 11.00)%] was remarkably lower than that of normal subjects (92.63 +/- 7.55)%] (P < 0.05), while platelet GP IIb and IIIa were not changed in any cases. CONCLUSION: The P-selectin levels in plasma and on platelet surface were increased while platelet membrane GP Ib was decreased in DM type II patients with vascular events.