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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。
AIM: To investigate the mechanism of fibrinolysis inhibition by thrombin-activated fibrinolysis inhibitor (TAFI) and plasminogen activator inhibitor-1 (PAI-1) in type 2 diabetes mellitus (T2DM) and to analyze the mechanism of TAFI, PAI-1 , Tissue-type plasminogen activator (t-PA), prothrombin fragment 1 +2 (F1 +2) coagulation, fibrinolysis and urine microalbumin relationship. Methods: Sixty - four patients with type 2 diabetes were divided into two groups according to urinary protein excretion: microalbuminuria (MAU) and normal proteinuria (NAU). TAFI, PAI-1, t-PA and F1 + 2 coagulation and fibrinolysis were measured by enzyme-linked immunosorbent assay (ELISH), and the above indexes were compared with urinary microalbuminuria, blood pressure, blood glucose, Relationship between. Results: Compared with the control group, plasma TAFI increased only significantly in MAU group (P <0.05); plasma t-PA had no significant increase in T2DM group; while PAI-1 and F1 + And MAU group were significantly higher, the difference was statistically significant (P <0.01). However, TAFI, PAI-1, t-PA, F1 + 2 in the two groups no significant difference. Conclusions: The decrease of fibrinolytic function in patients with type 2 diabetes is mainly due to the action of PAI-1. With the appearance of proteinuria, the further fibrinolytic state is mediated by TAFI. Therefore, inhibition of TAFI and PAI-1 The function of fibrinolytic system is independent.