NIDDM患者血浆纤溶酶原激活物抑制剂-1(PAI-1)与并发冠心病关系的探讨

Relationship between Plasminogen Activator Inhibitor1(PAI1) and Coronary Disease in NIDDM

为明确血浆纤溶酶原激活物抑制剂－１（ＰＡＩ－１）在ＮＩＤＤＭ发生冠心病中所起的作用，并分析其影响因素。将６０例ＮＩＤＤＭ患者分为冠心病（ＣＡＤ）组和非ＣＡＤ组，用底物发光法检测血浆ＰＡＩ－１及组织型纤溶酶原（ｔ－ＰＡ），同时检测血糖、血胰岛素、血脂等指标。结果表明：ＣＡＤ组血浆ＰＡＩ－１活性水平明显高于非ＣＡＤ组，分别为１０．０６±２．５与８．０８±２．６２，单位Ａｕ／ｍｌ，Ｐ＜０．０１。两组ｔ－ＰＡ相似。在ＣＡＤ组，血浆ＰＡＩ－１活性与空腹胰岛素、胰岛素敏感指数均相关，相关系数分别为０．２４（Ｐ＜０．０５）与－０．３（Ｐ＜０．０１），且与甘油三酯呈正相关（ｒ＝０．２４，Ｐ＜０．０５），和ＡｐｏＢ正相关（ｒ＝０．５１，Ｐ＜０．０５）。血浆ＰＡＩ－１活性水平的升高与ＮＩＤ－ＤＭ发生ＣＡＤ危险性存在相关。胰岛素抵抗状态、高胰岛素血症、高ＴＧ水平都可刺激血浆ＰＡＩ－１活性的升高，而高血糖对其无直接的作用。ＡｐｏＢ参与ＰＡＩ－１活性改变这一过程，并在ＣＡＤ发生中可能介导其它脂质异常刺激ＰＡＩ－１升高的作用。

The current study used chromogenic substrate assay to measure PAI1 plasma activity in 18 NIDDM with coronary artery disease (CAD group) and 42 NIDDM without CAD (nonCAD group). The result showed significant difference between these two groups: 1006±25 vs 808±262 Unit: Au/ml,P<001。PAI1 activity was related with fasting insulin,index of insulin sensitivity and triglycerides in the both groups. We found ApoB was related with PAI1 in CAD group (r=0.51,P<0.05),but not in nonCAD group.We concluded that higher level of PAI1 in NIDDM raised the risk of CAD,and this was influenced by insulin resistance and triglycerides,and ApoB had an unclear effect on PAI1. 