2型糖尿病视网膜病变与血浆纤溶相关因子的相关性

目的:探讨2型糖尿病视网膜病变患者血浆中纤溶相关因子与糖尿病视网膜病变的关系.方法:临床对照实验研究连续106例2型糖尿病患者,其中有糖尿病视网膜病变(diabetes retinopathy,DR)者51例(DR组),无DR者55例(无DR组),正常对照组47例.采用酶联免疫吸附法(ELISA)检测血浆中可溶性血栓调节蛋白(soluble thrombomodulin,STM)、组织纤溶酶原激活物(tissue plasminogen-activator,TPA)、纤溶酶原激活抑制物(plasminogen-activator inhibitor,PAI)和纤溶酶-a2-抗纤溶酶复合物(plasmin-a2-antiplasmin complex,PAP),用发色底物法检测蛋白C(protein C,PC).结果:2型DR患者血浆中纤溶相关因子明显高于无DR组和正常对照组(P＜0.01),在DR组和无DR组STM与PC呈负相关(r=-0.49,-0.45),STM与PAP呈正相关(r=0.47,0.46).结论:2型糖尿病患者血浆纤溶相关因子增高,参与凝血和纤溶系统活化,与DR的形成、发生和发展有密切关系.测定血浆中纤溶相关因子对于DR的早期诊断、预防和治疗具有重要临床意义.

Significance of plasma proteins related with fibrinolytic system in the type-2 diabetic retinopathy

Objective: To study the relationship between plasma proteins related with fibrinolytic system and retinopathy in patients with type 2 diabetes mellitus.Methods: A total of 106 cases of consecutive patients with type-2 diabetes mellitus were studied including 51 cases with diabetes retinopathy(DR) and 55 without DR,and 47 as the controls.The activities of soluble thrombomodulin(STM),tissue plasminogen-activator(TPA),plasminogen-activator inhibitor(PAI) and plasmin-a2-antiplasmin complex(PAP)were measured by ELISA method.The proteinC(PC) was measured by chromogenic substance method.Results: The level of plasma proteins related with fibrinolytic system in type 2 diabetic patients with DR was significantly higher than that of without-DR and normal controls(P<0.01,P<0.001 respectively).The concentration of STM was negatively correlated with the activity of Protein C(r=-0.49,-0.45 respectively)and positively correlated with PAP(r=0.47,0.46 respectively)with-DR and without-DR in type 2 diabetic patients.Conclusion: The increase of the plasma proteins related with fibrinolytic system,is associated with hypercoagulability and enhanced fibrinolysis and it plays a role in the initiation and progression of type 2 diabetic retinopathy.The measurement of plasma proteins related with fibrinolytic system has important clinical value of early diagnosis and treatment for DR.