t-PA、PAI活性测定在早期糖尿病肾病临床中的意义

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

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t-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。

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.