2型糖尿病合并冠心病与血浆纤溶酶原激活物抑制剂1水平的相关性研究

Relationship of plasma plasminogen activator inhibitor type 1 level and type two diabetes mellitus patients with coronary heart disease

目的阐明纤溶酶原激活物抑制剂1(PAI-1)在2型糖尿病合并冠心病发生发展中的作用和机制,寻找临床防治2型糖尿病和冠心病的新方法。方法确诊的2型糖尿病患者66例,根据1979年WHO冠心病诊断标准及冠状动脉造影的结果,分为单纯2型糖尿病组30例,2型糖尿病合并冠心病组36例;选择同期正常健康人30例(年龄、性别与糖尿病两组匹配)作为正常对照组;测定所有观察对象的空腹血浆PAI-1水平、体质量指数(BMI)、空腹血糖、空腹胰岛素(FINS)、血脂及尿白蛋白排泄率等相关指标;用稳态模式胰岛素抵抗指数(Homa-IR)评估胰岛素抵抗。结果2型糖尿病两组血浆PAI-1水平、Homa-IR高于正常对照组,2型糖尿病合并冠心病组高于单纯糖尿病组(P<0.05);超体质量肥胖组[男腰臀比(WHR)≥0.90,女WHR≥0.85]血浆PAI-1水平高于非肥胖组(男WHR<0.90,女WHR<0.85)(P<0.05);相同WHR水平间PAI-1水平依正常对照组、单纯2型糖尿病组、2型糖尿病合并冠心病组逐渐升高;PAI-1与BMI、WHR、FINS、总胆固醇、Homa-IR呈正相关(P<0.05)。结论PAI-1与2型糖尿病、冠心病、胰岛素抵抗之间存在密切的相关性,在2型糖尿病、冠心病的发生发展中发挥重要作用;测定血浆PAI-1可以作为2型糖尿病冠心病的预测因子。

Objective To clarify the effect and mechanism of plasminogen activator inhibitor type I（PAI-1） in the occurrence and development of type two diabetes mellitus（T2DM） with coronary heart disease（CHD）. The aim is to find a new method in preventing and treating T2DM and CHD. Methods Sixty-six patients diagnosed as T2DM, were divided into two groups, one group pure T2DM which consisted of 30 patients and the other group T2DM with CHD which consisted of 36 patients. Thirty health people at the same stage, whose age and sex were similar with those in T2DM group served as normal control group. Enzyme-linked immunoadsordent assay （ELISA） was used to determine the level of their fasting plasma PAI-1 and their relevant indexes such as body mass index（BMI）, fasting blood glucose （ FBG）, fasting blood insulin （FINS）, hemoglobinA1c （ HbA1 c） and urinary albumin excretion rate （UAER）. Homa-IR were calculated. Results Plasma PAI-1 level and Homa-IR in both T2DM groups were higher than those in normal control group（ P 〈0.01）. The levels of PAI-1 and Homa-IR in T2DM with CHD were higher than those in pure T2DM（ P〈0.05）. Non-obesity group and overweight obesity group were divided according to waite hip ratio（WHR）, comparison of different WHR showed plasma PAI-1 levels in overweight obesity group was higher than non-obesity group. At the same WHR level, PAI-1 level was gradually rising in the order of normal control, T2DM and T2DM with CHD. Analysis of the relation between plasma PAI-1 level and other factors proved plasma PAI-1 level was positively correlated with BMI, WHR, FINS, total cholesterol, Homa-IR（ P〈0.05）. Conclusion There was close relation of PAI-1 to T2DM, CHD and insulin resistance. Plasma PAI-1 played an important part in the occurrence and development of T2DM and CHD. Plasma PAI-1 was involved in the occurrence and development of T2DM with CHD. Measurement of PAI-1 could be used as a predictive factor for T2DM with CHD.