t-PA、PAI活性测定在早期糖尿病肾病临床中的意义

目的 探讨2型糖尿病（T2DM）患者及糖尿病肾病（DN）患者中尿白蛋白排泄率（UAER）与血浆组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制物（PAI）活性的相关性。方法 选择60例T2DM病人，根据UAER分为单纯糖尿病（DMa）组、微量白蛋白尿组（DMb）和临床蛋白尿组（DMc）。此外，还选择了30例健康人作为对照组。采用发色底物显色法测定血浆t-PA和PAI的活性，并对其相关性进行统计分析。结果 （1）对照组、DMa组、DMb组和DMc组血浆卜PA活性递减，PAI的活性递增，各组比较有显著性差异（P〈0．01）。（2）t-PA与UAER呈负相关（r=0．615，P=0．000），PAI和UAER呈正相关（r=0．721，P=0．000）。结论 DN早期即有纤溶活性低下；t-PA和PAI可能作为DN肾脏损害程度的佐证，对指导临床用药以缓解或延迟DN的发生具有重要意义。

The clinical significance of determination of tissue plasminogen activator and plasminogen activator inhibitor activity in patients with the early diabetic nephropathy

Objective To investigate the relationship between urinary albumin excretion rate(UAER) and plasma tissue plasminogen activator(t-PA) , plasminogen activator inhibitor(PAI) activity in patients with type 2 diabetes mellitus(T2DM) and diabetic nephropa thies(DN). Methods 60 cases with T2DM were divided into simplex DM group(DMa) , microalbunminuria( MAU) group(DMb) , and proteinuria group(DMc). Moreover 30 normal cases serve as control group. The t-PA and PAI activity were detected with chromogenic substrate assay to analyze their correlation. Results (1) In control, DMa, DMb and DMc groups, there was a reducing tendency in t-PA activity while a progressive tendency in PAI activity with significant differences among these groups(P <0. 001). (2) UAER showed a negative correlation(r = -0.615, P = 0.000) with t-PA and a positive one with PAI activity(r= 0.721, P=0.000) respectively. Conclusions There are lowered plasminogen activities in early DN, t-PA and PAI could be evidences of kidney damage degree of DM, which could play significant roles in guiding administer to delay development of DN.