Ⅱ型糖尿病患者血浆可溶性凝血酶调节蛋白的变化及临床意义

目的 评价血浆可溶性凝血酶调节蛋白与Ⅱ型糖尿病患者凝血和纤溶系统之间的关系。方法 我们检测了50例Ⅱ型糖尿病患者血浆中可溶性凝血酶调节蛋白、蛋白C(PC)(由凝血酶-TM复合物诱导产生的抗凝物质)、凝血酶原片段F1+2(一种凝血酶生成的直接标志物)、纤溶酶-α2-抗纤溶酶复合物(PAP)和D二聚体(DD)。结果 患者血浆中的sTM(P<0.01)、PAP(P<0.01)、PC(P<0.05)和F1+2(P<0.05)较50例正常对照组明显增高,糖尿病肾病患者的sTM和PAP升高更加显著。在糖尿病患者中,sTM与PC呈负相关(r=-0.50,P<0.001),而与PAP呈正相关(r=0.47,P=0.01)。结论 结果表明糖尿病患者的凝血和纤溶系统均是活化的,血浆中的可溶性凝血酶调节蛋白升高与糖尿病患者凝血和纤溶系统活化相关。

Change of soluble thrombomodulin and its clinical significance in type 2 diabetes

Objective To evaluate the relationship of soluble TM in plasma between coagulation and/or fibrinolysis system in patients with diabetes. Methods We measured plasma soluble TM,protein C activity,prothrombin F1+2,and plasmin-α2-antiplasmin complex(PAP) and D dimmer in 50 patients with type 2 diabetes mellitus and 50 corresponding healthly subjects. Results The plasma concentrations of soluble TM(P <0.01),PAP(P < 0.01),protein C activity(P <0.05) and prothrombin F1+2 (P <0.05) were significantly higher in the diabetic patients than the 50 age-matched control subjects. The plasma concentrations of TM and PAP were obviously increased in patients with diabetic nephropathy In the diabetic patients, the plasma concentrations of sTM were inversely correlated with the protein C activity(r = -0.50, P < 0.001) ,and were positively correlated with the plasma concentration of PAP( r = 0.47, P < 0.001) . Conclusions the result demonstrats that both coagulation and fibrinolysis are enhanced concomitantly in patients with type 2 diabetes mellitus,and that an increase in plasma concentration of soluble TM is associated with hypercoagulability and enhanced fibrinolysis in diabetic patients.