Low-grade risk of hypercoagulable state in patients suffering from diabetes mellitus type 2

2型糖尿病患者高凝血状态的研究

Objective： Diabetes, including type 1 and type 2, is associated with the hypercoagulable state. The aim of this study is to evaluate the concentration of selected hemostatic parameters and vascular endothelial growth factor-A （VEGF-A） in diabetic subjects. Methods： The study was conducted in 62 patients with diabetes. Group I consisted of 27 patients having uncontrolled diabetes with microalbuminuria and Group II included 35 well-controlled diabetic patients. The control group was made up of 25 healthy volunteers. In the citrate plasma, the concentrations of tissue factor （TF）, tissue factor pathway inhibitor （TFPI）, thrombin-antithrombin （TAT） complexes, and D-dimer were assayed. Serum concentrations of VEGF-A, lipid profile, creatinine, and plasma fasting glucose were measured and in the versene plasma the concentration of HbAlc was determined. Results： In the patients with uncontrolled diabetes, higher con- centrations of TF, TFPI, and VEGF-A were observed, as compared with the well-controlled diabetics group and the control group. A significantly lower activity of antiplasmin was reported in patients from Group I as compared with the control group. In Group I, using the multivariate regression analysis, the glomerular filtration rate was independently associated with VEGF-A and dependently associated with total cholesterol. Conclusions： The study showed higher concentrations of TF and TFPI in the patients with uncontrolled diabetes with microalbuminuria, which is associated with rapid neutralization of the thrombin formation, since TFPI inhibits the complex of TF/VIIa/Ca2＋. The manifestation of the above suggestions is the correct TAT complexes and D-dimer, which indicates a low grade of prothrombotic risk in this group of patients, but a higher risk of vascular complications.

目的:评估糖尿病病人的止血参数和血管内皮生长因子的浓度。方法:62例糖尿病患者分成两组:第一组包括35个血糖控制良好的糖尿病患者,第二组包括27个未控制血糖并伴有微蛋白尿的糖尿病患者。对照组由25名健康志愿者组成。测定血浆中组织因子(TF)、组织因子途径抑制剂(TFPI)、凝血酶抗凝血酶复合物(TAT)和D-二聚体的浓度。同时测定血清中内皮生长因子A(VEGF-A)、血脂、肌酐和血浆空腹血糖及糖化血红蛋白(HbA1c)的浓度。结论:研究表明,未控制血糖并伴有微蛋白尿的糖尿病患者具有更高的浓度的TF和TFPI,这与凝血酶形成的快速中和有关。TAT复合物和D-二聚体的正确形成,能保证患者具有一个相对较低级凝血风险,但同时会带来更高的血管并发症的风险。