糖尿病患者血栓前状态研究

采用流式细胞仪、ELISA法、全自动血凝分析仪,检测糖尿病患者血小板表面P-选择素(CD62P)的表达、血浆组织型纤溶酶原激活剂(t-PA)、抑制剂(PAI-1),以及凝血4项,即血浆纤维蛋白原(Fib)水平、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)。结果显示,糖尿病组血小板表面CD62P的表达、血浆PAI-1、Fib 3项指标均较正常组增高(P<0.05),而t-PA水平较正常组降低(P<0.05);糖尿病组APTT、PT及TT时间明显缩短(P<0.05);糖尿病伴血管病变组血小板表面CD62P的表达、血浆PAI-1、Fib 3项指标均较不伴血管病变组增高(P<0.05);糖尿病伴血管病变组APTT及TT较不伴血管病变组明显缩短(P<0.05);糖尿病伴血管病变组血浆t-PA水平、PT与不伴血管病变组指标比较没有显著性差异(P>0.05)。研究表明,糖尿病及糖尿病伴血管病变患者血小板活化、凝血功能增强、纤溶功能减退,存在明显的血栓前状态;测定血小板表面CD62P的表达、血浆t-PA、PAI-1,以及凝血4项,即血浆Fib水平、APTT、PT、TT等有助于早期发现血栓前状态及血管病变,并可以指导临床早期干预治疗。

Study on the Prethrombotic State in Diabetes Mellitus

The expression of CD62P on platelets,the level of plasma tissue Plasminogen Activator(t-PA),Plasminogen Activator lnhibitor-1(PAl-1),Activated Partial Thromboplastin Time(APTT), Fibrinogen(Fib),Prothrombin Time(PT)and Thrombin Time(TT) were tested by using flow cytometer,ELISA method and auto coagulometer.Compared to the control group,the average expression of CD62P,the level of plasma Fib and plasma PAI-1 in diabetes group were increased(P<0.05),the level of t-PA in diabetes group was decreased,APTT,PT and TT were significantly shortened;the expression of platelet CD62P,the level of plasma PAI-1 and Fib in the group with angiopathy were significantly increased as compared to that of the group without angiopathy(P<0.05);the APTT and TT in the group with angiopathy were significantly shortened as compared to that of the group without angiopathy(P<0.05);there was no significant difference on plasma t-PA level and PT between the group with angiopathy and that without angiopathy(P>0.05).There is an increased platelet activation,thrombin activity,lower fibrinolytic function in diabetes and diabetes with angiopathy patients;there is an obvious prethrombotic state in diabetes and diabetes with angiopathy patients.Determination of platelet CD62P expression,plasma t-PA,plasma PAI-1,plasma Fib,APTT,PT and TT may contribute to early diagnose of thrombosis and angiopathy occurrence,warranting clinical treatment in early stage.