糖尿病肾病患者血浆血栓调节蛋白和D-二聚体的变化及意义

Plasma Thrombomodulin and D-dimer Levels in Patients with Diabetic Nephropathy

目的:观察2型糖尿病患者不同程度肾病血浆血栓调节蛋白(TM)和D-二聚体(D-D)的变化,了解其在糖尿病肾病发病中的意义。方法:用ELISA法测定58例2型糖尿病和21例正常对照者血浆TM和D-D浓度。结果:2型糖尿病患者血浆TM和D-D水平明显高于正常对照组;糖尿病肾病患者血浆TM和D-D水平明显高于糖尿病非肾病患者;慢性肾衰组血浆TM水平高于微量白蛋白尿组和临床蛋白尿组;临床蛋白尿组血浆TM水平高于微量白蛋白尿组;TM与空腹血糖(FPG)、血尿素氮(BUN)、肌酐(Cr)、纤维蛋白原(FIB)、尿微量白蛋白(UMA)、糖尿病视网膜病变(DR)呈正相关;D-D与患者年龄、FPG、BUN、Cr、FIB、UMA、DR呈正相关。结论:血浆TM受肾功能的影响,可以作为糖尿病肾病的早期预测因素。肾功能受损、年老、高血糖均会导致体内高凝状态。

Objective： To study the significance of thrombomodulin （TM） and D-dimer （D-D） in the pathogenesis of diabetic nephropathy by evaluating the plasma levels of TM and D-D in patients with diabetic nephropathy. Methods： The plasma levels of TM and D-D were measured using ELISA in 58 patients with type II diabetes mellitus and in 21 control subjects. Results： The plasma levels of TM and D-D were significantly higher in the diabetic patients than those in the control subjects. These figures were also significantly higher in the diabetic patients with nephropathy than those without nephropathy. The plasma level of TM was higher in patents with chronic renal failure than that in patients with microalbuminuria or clinical proteinuria. The plasma level of TM was higher in patients with clinical proteinuria than that in patients with microalbuminuria （P 〈 0.05）. In the diabetic patients, the plasma levels of TM were positively Correlated with fasting plasma glucose（FPG）, blood urea nitroge（BUN）, creatinine （Cr）, fibrinogen （FIB） , urine microalbumin （UMA） and diabetic refinopathy （DR）. The plasma levels of D-D were positively correlated with age, FPG, BUN, Cr, FIB, UMA and DR in patients. Conclusion： The plasma levels of TM are affected by renal function. Plasma TM levels in diabetic patients might be predictors for very early nephropathy. Hyperglycemia, and impaired renal function could induce hypercoagulation in diabetic patients.