凝血酶激活的纤溶抑制物、纤溶酶原激活剂抑制物-1与非肥胖型2型糖尿病患者代谢参数的相关性

Correlation between metabolic parameters of non-obesity type 2 diabetic patients and functions of thrombin-activatable fibrinolysis inhibitor and plasminogen activator inhibitor-1

目的探讨凝血酶激活的纤溶抑制物(TAFI)、纤溶酶原激活剂抑制物-1(PAI-1)与非肥胖型2型糖尿病患者代谢参数的相关性。方法将57例有血管病变的非肥胖型2型糖尿病患者分为实验1组,39例无血管病变的非肥胖型2型糖尿病患者分为实验2组,80例健康者作为对照组。检测TAFI、PAI-1、血管性假性血友病因子(vWF)及纤维蛋白原(FIB)水平,测定空腹血糖、糖化血红蛋白、空腹胰岛素水平、脂代谢指标及体重指数等参数。结果与对照组比较,实验1组TAFI、PAI-1、vWF、FIB水平显著升高(P<0.01);与对照组比较,实验2组TAFI、PAI-1、vWF、FIB水平升高(P<0.05);与实验2组比较,实验1组TAFI、PAI-1水平升高(P<0.05)。Pearson相关分析表明TAFI与空腹血糖、糖化血红蛋白呈正相关(分别为r=0.29,P<0.05;r=0.71,P<0.01),PAI-1与体重指数呈正相关(r=0.33,P<0.05),TAFI与PAI-1之间无相关性。结论非肥胖型2型糖尿病患者凝血活性增强,存在低纤溶状态;非肥胖型2型糖尿病患者血浆中TAFI水平升高与长期的高血糖有关,而脂肪蓄积是PAI-1增多的主要根源。

Objective To assess the effect of thrombin-activatable fibrinolysis inhibitor （TAFI）, plasminogen activator inhibitor-1 （PAI-1） in non-obesity type 2 diabetic patients, and to invesw tigate the relationship between TAFI, PAI-1 and clinical parameters of metabolism. MethodsThe individuals confined to the enrolling criteria were divided into three groups. Group 1 in- cluded 57 cases of non-obesity type 2 diabetic patients with vascular lesion; group 2 consisted of 39 non-obesity type 2 diabetic patients with no vascular lesion; and the 80 enrolled healthy individuals were regarded as normal control group. The levels of plasma TAFI, PAI-1, von Wille- brand factor （vWF） and fibrinogen （FIB） were measured. The changes of fasting blood glucose, glycosylated hemoglobin, fasting insulin, body mass index and lipid metabolism indicators were detected as well. Results Compared with the plasmic levels of TAFI, PAI-1, vWF, FIB in nor- mal control group, the levels in group 1 were obviously higher （P 〈0.01）, and TAFI, PAI-1, vWF, FIB in group 2 dramatically increased with significant difference （P 〈0.05）. Compared with the plasmic levels of TAFI, PAI-1 in group 2, the levels in group 1 obviously increased （P 〈0.05）. The significantly positive correlations were found between plasmic TAFI level and serum fasting blood glucose levels, or serum glycosylated hemoglobin levels （r=0.29, P 〈0.05; r=0.71, P 〈0.01 respectively）. Another positive correlation was also observed between the plasmic PAI-1 level and body mass index （r= 0.33, P 〈0.05）. There was no relationship between the changes of plasma PAL1 and TAFI levels. Conclusion The findings suggest that the coagulation activity can be enhanced in non-obesity type 2 diabetic patients accompanied by decreased activity of fibrinoly- sis. The level increase of plasma TAFI is related with the long-term high blood sugar, which is a valuable marker to assess the deterioration of disease, and the fat accumulation is involved in the PAI-1 level increase in disease.