NIDDM病人红细胞变形能力与膜骨架结构和收缩蛋白的关系

THE RELATIONSHIP BETWEEN ERYTHROCYTE DEFORMABILITY AND ERYTHROCYTE MEMBRANE SKELETON STRUCTURE AND SPECTRIN IN PATIENTS WITH NIDDM

①目的探讨非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人红细胞变形能力（ＥＤ）与红细胞膜骨架结构和收缩蛋白（ＳＰ）的关系。②方法采用ＤＸＣ－３００Ａ型核孔膜红细胞变形能力测定仪、ＪＥＭ－１２００ＥＸ透射电镜和ＳＤＳ－聚丙烯酰胺凝胶电泳法，检测了６４例ＮＩＤＤＭ病人和３９例正常人红细胞滤过指数（ＥＦＩ）、红细胞膜骨架结构和收缩蛋白二聚体（ＳＰ－Ｄ）和四聚体（ＳＰ－Ｔ）的变化。③结果ＮＩＤＤＭ病人ＥＦＩ，ＳＰ－Ｄ，ＳＰ－Ｄ／ＳＰ－Ｔ明显增高，而ＳＰ－Ｔ明显减少，与对照组比较差异均有显著性（ｔ＝３．８６～１１．５２，Ｐ均＜０．００１），且有血管病变者较无血管病变者变化更明显（ｔ＝４．８８～１４．６７，Ｐ均＜０．００１）。ＮＩＤＤＭ病人ＥＦＩ与ＳＰ－Ｄ，ＳＰ－Ｄ／ＳＰ－Ｔ呈正相关（ｒ＝０．５１７，０．５３６，Ｐ均＜０．００１），与ＳＰ－Ｔ呈负相关（ｔ＝－０．５５０，Ｐ＜０．００１）。ＮＩＤＤＭ病人红细胞膜骨架结构松散，部分缺失，纤维粗丝不一，有许多纤维断裂或融合，网眼大小不一。

Objective To explore the relationship between the erythrocyte deformability (ED) and erythrocyte membrane skeleton structure and spectrin(SP) of patients with non insulin dependent diabetes mellitus(NIDDM). Methods The changes of the erythrocyte filtration index( EFI) ,erythrocyte membrane skeleton structure, spectrin dimers(SP D) and spectrin tetramers(SP T) were measured in 64 patients and 39 controls by using the DXC 300A erythrocyte deformability apparatus,JEM 1200EX transmission electron microscope and SDS gel eletrophoretic analysis. Results EFI, SP D, SP D/SP T were markedly higher, and SP T were significantly lower in NIDDM patients than those in controls( t= 3.86—1.52, P <0.001), the increase of EFI,SP D, SP D/SP T and decrease of SP T were more obvious in patients with angiopathy than that in patients without( t=4.88—14.67,P< 0.001).The EFI was positively correlated with SP D, SP D/SP T( r=0.517,0.536, P< 0. 001),and negatively correlated with SP T( r=0.550,P <0.001). In NIDDM patients, the erythrocyte membrane skeleton structure was loose, blurred and partially deficient. Many spectrin filaments disrupted and fused to form uneven skeletal lattice. Conclusion The decrease of ED in patients with NIDDM might be closely related to the injury of erythrocyte membrane skeleton structure and the abnormalities of spectrin.