2型糖尿病纤溶系统变化与胰岛素抵抗的关系

Relationship between changes of fibrinolysis in type 2 diabetes mellitus and insulin resistance

目的探讨2型糖尿病患者纤溶活性变化与胰岛素抵抗之间的关系。方法采用酶联免疫吸附法测定63例2型糖尿病患者(包括无血管并发症组30例和有血管并发症组33例)和25例正常对照者血浆组织型纤溶酶原激活剂(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)含量,结合临床资料分析其变化趋势及影响因素。结果2型糖尿病患者血浆t-PA含量明显降低(P<0.01),而PAI-1含量明显升高(P<0.01),合并血管病变者,此变化更为显著(均P<0.001)。多元逐步回归分析显示,HOMA模型胰岛素抵抗指数(HOMA-IR)是PAI-1升高的独立危险因素。结论2型糖尿病患者纤溶活性降低,胰岛素抵抗在降低其纤溶活性,并发血管病变中起了重要作用。

Objective To investigate the relationship between changes of fibrinolysis in type 2 diabetes mellitus and insulin resistance. Method The serum levels of tissue-type plasminogen activator （t- PA） and its inhibitor, plasminogen activator inhibitor-1 （ PAI-1 ） in 63 diabetic patients （ including 30 cases without diabetic angiopathies and 33 cases with diabetic angiopathies ） and 25 normal controls were measured by ELISA method. We analyzed the change tendency and influential factors combining the clini- cal datas. Result In type 2 diabetic patients, the plasma t-PA level was significantly lower（P 〈 0.01 ） and PAI-1 was significantly higher （P 〈 0.01 ）than normal controls. Those with angiopathies, this change was more obvious （ respectively ,P 〈 0. 001 ）. By multiple stepwise regression analysis, HOMA-IR was an independent risk factor of PAI-1. Conclusion In type 2 diabetic patients, the fibrinolysis is impaired. Insuhn resistance appears to play an important role in decreasing fibrinolysis of diabetic patients and inducing angiopathies.