2型糖尿病微血管病变患者纤溶系统变化与胰岛素抵抗的关系

Relationship between fibrinolysis change and insulin resistance in type 2 diabetes mellitus with microangiopathy

目的探讨2型糖尿病微血管病变患者纤溶活性变化与胰岛素抵抗(IR)之间的关系。方法采用酶联免疫吸附试验测定53例2型糖尿病患者(包括无血管并发症组30例和微血管并发症组23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,而PAI-1含量明显升高,t-PA分别是(7.09±2.10)μg/L vs(12.40±2.11)μg/L(P<0.05),PAI-1分别是(40.38±1.74)μg/L vs(25.28±2.83)μg/L(P<0.05),合并微血管病变者,此变化更为显著,t-PA分别(6.22±1.23)μg/L vs(12.40±2.11)μg/L,PAI-1分别是(44.57±2.16)μg/L vs(25.28±2.83)μg/L(均P<0.01)。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,IR在降低其纤溶活性,并发微血管病变中起了重要作用。

Objective To investigate the relationship between changes of fibrinolysis and insulin resistance in type 2 diabetes mellitus with microangiothy. Methods The serum levels of tissue-type plasminogen activator（t-PA） ,t- PA inhibitor-1 （PAI-1） in 53 diabetic patients （including 30 cases without diabetic angiopathies and 23 cases with diabetic microangiopathies ） and 25 normal controls were measured by enzyme linked immunosorbent assay（ELISA） method. The change tendency and influential factors were analyzed with the clinical data. Results In type 2 diabetic patients,t-PA level was significantly lower and PAI-1 was significantly higher than that of normal controls, （7.09 ± 2. 10） μg/L vs （12.40±2.11） μg/L, P d0.05） and （40.38± 1.74） μg/L vs （25.28± 2.83） μg/L（ P 〈0.05）. In type 2 diabetic patients with microangiopathies, this change was more obvious （6.22 ± 1.23） μg/L vs （ 12.40 ±2.11 ） μg/L, （44.57 ± 2.16） μg/L vs （ 25.28 ± 2.83 ） μg/L （ both P 〈 0.01 ）, respectively. 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. Insulin resistance appears to play an important role in decreasing fibrinolysis of diabetic patients and inducing microangiopathies.