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目的探讨T2DM患者血栓前状态包括血小板表面CD41,CD62p表达,内皮细胞损伤标志物和凝血指标的变化及其临床价值。方法用流式细胞术测定患者血小板表面CD41,CD62p;用放射免疫法检测血清内皮素-1(ET-1);用ELISA法检测血浆组织纤溶酶原激活物(t-PA)及其抑制物(PAI-1);全自动血凝分析仪检测凝血四项即血浆纤维蛋白原(FIB)水平、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)。结果 DM组血小板表面CD62p的表达、血浆PAI-1、FIB三项指标均较正常对照组(NC组)增高(P<0.05),而t-PA水平较NC组降低(P<0.05);DM组APTT、PT明显缩短(P<0.05)。糖尿病伴血管病变组血小板表面CD62p的表达、血浆PAI-1、FIB三项指标均较不伴血管病变组增高(P<0.05);糖尿病伴血管病变组APTT及TT较不伴血管病变组明显缩短(P<0.05)。结论血栓前状态若干相关分子标志物即ET-1、CD41、CD62p、t-PA、PAI-1及凝血四项的变化可能有助于预测DM血管并发症发生和发展及判断血管病变程度。
Objective To investigate the changes and clinical value of prethrombosis state of platelet in patients with T2DM including CD41 and CD62p expression, endothelial cell injury markers and coagulation indexes. Methods Flow cytometry was used to determine CD41 and CD62p on platelet surface. Serum endothelin-1 (ET-1) was detected by radioimmunoassay. Plasminogen activator (t-PA) and its inhibition (PAI-1). The levels of plasma fibrinogen (FIB), activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time ). Results The expression of CD62p on the surface of platelets in DM group was significantly higher than that in NC group (P <0.05), while the level of t-PA was lower in DM group than that in NC group (P <0.05) Group APTT, PT was significantly shorter (P <0.05). The expression of CD62p on the surface of platelets in patients with diabetes mellitus and the level of plasma PAI-1 and FIB in three groups were significantly higher than those in non-vascular group (P <0.05); APTT and TT in diabetic patients with vascular lesions were significantly shorter than those without vascular lesions (P <0.05). Conclusions The changes of some related molecular markers of prethrombosis, namely ET-1, CD41, CD62p, t-PA, PAI-1 and coagulation, may be helpful in predicting the occurrence and development of DM vascular complications and judging the degree of vascular lesions.