非胰岛素依赖型糖尿病患者血小板活化与微血管病变关系初探

Primary Study on the Relationship Between Platelet Activation and Microangiopathy in Patients with Non-Insulin-Dependent Diabetes Mellitus(DM2)

目的:探讨糖尿病患者血小板活化与微血管病变的关系。方法:采用流式细胞术测定77例非胰岛素依赖型糖尿病(NIDDM)患者(其中无微血管病变者41例,伴微血管病变者36例)及35例健康对照者的血小板颗粒膜糖蛋白(CD62p和CD63)、血小板膜表面糖蛋白(CD41、CD61和CD42b)及血小板凝血酶敏感蛋白(TSP),同时用RIA检测血浆内皮素(ET)和空腹血浆胰岛素(FINS)。结果:NIDDM组血小板CD62p、CD63和TSP阳性的百分率(1.51±0.73%、4.93±1.06%、79.37±11.17%)和CD41、CD61的平均荧光道数值(MnX)(15.62±4.22、7.78±1.91)显著高于健康对照组(0.49±0.26%、2.22±0.61%、63.58±9.37%、9.86±1.05、3.03±0.43)(P<0.05～0.01),伴微血管病变组又明显高于无微血管病变组(P<0.05～0.01)。NIDDM组血小板CD42b的阳性百分率显著低于健康对照组(P<0.05),但有无微血管病变组间的差异并不显著(P>0.05)。糖尿病患者血小板CD62p、CD63、CD61和TSP与血浆ET呈显著正相关(r=0.57、0.52、0.37和0.33,P<0.05～0.01)。结论:活化血小板测定对于糖尿病微血管病变的早期诊断具有重要的临床应用和研究价值。

Objective To study the relationship between microangiopathy and platelet activation in patients with non- insulin-dependent diabetes mellitus （NIDDM）. Methods The plasma levels of platelet membrance glycoprotein （ CD62p, CD63, CD41, CD61 ,CD42b ,TSP） were measured with flow cytometry （FCM） in 77 patients with NIDDM （ including 41 patients without mieroangiopathy and 36 patients with microangiopatly） and in 35 controls. The plasma level of endothelin （ET） and insulin were also measured with RIA and serum FPG was measuvod with biochemistry. Results The positive percentages of platelet CD62p, CD63 and TSP and MnX of CD41 and CD61 in patients with NIDDM were 1.51 ± 0.73%, 4.93 ± 1.06%, 79.37 ± 11.17%, 15.62 ± 4.22 and 7.78 ± 1.91 respectively, which were significantly higher than those in controls （0.49 ± 0.26%, 2.22 ± 0.61% ,63.58 ±9.37% ,9.86 ± 1. 05 and 3.03 ± 0.43 respectively） （ P 〈 0.05 - 0.01 ）. The levels of platelet glycoproteins in NIDDM patients with microangiopathy were significantly higher tham those in patients without microangpathy （P 〈0.05 -0.01）. The level of platelet CD42b in patients with NIDDM was significantly lower than those in controls （ P 〈 0.05） . The platelet CD62p, CD63, CD61 percentage and TSP were positively correlated with the plasma level of ET （r=0.57, 0.52, 0.37 and 0.33 respectively, P〈0.05 -0.01）. Conclusion The measurement of parameters of platelet activation is of clinical value in the erly diagnosis and study of pathophysiology in NIDDM patients with microangiophy.