2型糖尿病患者TAFI、PAI-1、t-PA、F1+2与尿微量蛋白之间关系的研究

The relationship among TAFI,t-PA,PAI-1 and F1+2 in type 2 diabetic patients with normoalbuminuria and microalbuminuria

目的:探讨凝血酶激活的纤溶抑制物(TAFI)和纤溶酶原激活物抑制剂-1(PAI-1)在2型糖尿病患者中纤溶抑制的作用机制,并分析TAFI、PAI-1、组织型纤溶酶原激活剂(t-PA)、凝血酶原片段1+2(F1+2)等凝血、纤溶的指标与尿微量蛋白之间的关系。方法:64例2型糖尿病患者以尿蛋白排泄量分微量蛋白尿组(MAU)和正常蛋白尿组(NAU)组。TAFI、PAI-1、t-PA及F1+2等凝血纤溶指标测定用酶联免疫吸附双抗体夹心法(ELISH),并分析上述指标与尿微量蛋白、血压、血糖、血脂、功能参数之间的关系。结果:与对照组比较,血浆TAFI仅在MAU组显著性升高(P<0.05);血浆t-PA在T2DM的2组中增高均无显著性;而血浆PAI-1和F1+2在NAU和MAU组均显著性增高,差异有统计学意义(P<0.01)。但TAFI、PAI-1、t-PA、F1+2在2组之间无显著性差异。结论:2型糖尿病患者的纤溶功能降低主要是由于PAI-1的作用,随着蛋白尿的出现,其进一步的低纤溶状态则是由TAFI介导的,故TAFI和PAI-1在抑制纤溶系统功能上的作用是独立的。

Objective：The aim of the study was to investigate the relationship among plasminogen activator inhibitor 1（PAI-1）,thrombin-activable fibrinolysis inhibitor（TAFI）,tissue plasminogen activator（t-PA）,prothrombin fragments 1＋2（F1＋2）,glycemic control,hypertension and body mass index（BMI）in T2DM patients with normoalbuminuria and microalbuminuria.Method：Thirty-two normoalbuminuric（NAU）,32 microalbuminuric（MAU）patients with T2DM and 36 blood donors as control group were enrolled.TAFI,PAI-1,t-PA and F1＋2 were assessed by enzyme-linked immunosorbent assay（ELISA）in all patients.Result：TAFI was significantly increased in the MAU group,PAI-1 and F1＋2 were increased in both groups and t-PA was not elevated in either group compared to controls.Conclusion：We found decreased fibrinolysis in T2DM patients presented with increased PAI-1 in both NAU and MAU.Hypofibrinolysis in MAU is further accented by the elevation of TAFI.TAFI mediated inhibition of fibrinolysis in T2DM is regulated independently from PAI-1.