Rigla M, Mateo J, Fontcuberta J, Souto J C, de Leiva A, Pérez A
Department of Endocrinology and Nutrition, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Spain.
Thromb Haemost. 2000 Aug;84(2):223-7.
Increased plasma concentrations of various markers of endothelial damage have been observed in type I diabetic patients, particularly in those with microangiopathy.
To evaluate the effect of near-normalisation of glycaemic control on different markers of endothelial injury involved in haemostasis in poorly-controlled type 1 diabetic patients.
TFPI, thrombomodulin (TM), plasminogen activator inhibitor, tissue-type plasminogen activator and von Willebrand factor were measured in 14 poorly-controlled type 1 diabetic patients free of diabetes-related complications (8 men, 6 women; mean age 29.8 +/- 9.9 years) before (baseline) and after 3 months of intensive therapy and in 14 sex-, age- and BMI-matched control subjects.
After a mean follow-up of 107 +/- 49 days (56-210), HbA1c decreased from 11.2 +/- 2.3 to 6.7 +/- 0.7% (p <0.0001). TFPI activity at baseline was higher than in the control group (126.9 +/- 34 vs 92.0 +/- 13%, p <0.005) and decreased after good glycaemic control was achieved (p <0.005), becoming similar to that in the control group (91.0 +/- 16.5%). The TFPI descent correlated with the variations observed in HbA1c (p <0.05; r = 0.54). TM levels at baseline were significantly higher than in the control group (42.3 +/- 9.1 vs 29.00 +/- 10.9; p <0.005) and did not change. The remaining parameters studied were similar between patients and controls and did not change after glycaemic optimisation.
Optimisation of glycaemic control normalises the increased activity of TFPI but not the higher TM levels observed in poorly-controlled type I diabetic patients without chronic complications.
在I型糖尿病患者中，尤其是患有微血管病变的患者，已观察到血浆中各种内皮损伤标志物的浓度升高。
评估血糖控制接近正常对控制不佳的1型糖尿病患者止血过程中涉及的不同内皮损伤标志物的影响。
在14名无糖尿病相关并发症的控制不佳的1型糖尿病患者（8名男性，6名女性；平均年龄29.8±9.9岁）强化治疗前（基线）和3个月后，以及14名性别、年龄和BMI匹配的对照受试者中，测量组织因子途径抑制物（TFPI）、血栓调节蛋白（TM）、纤溶酶原激活物抑制剂、组织型纤溶酶原激活物和血管性血友病因子。
平均随访107±49天（56 - 210天）后，糖化血红蛋白（HbA1c）从11.2±2.3降至6.7±0.7%（p<0.0001）。基线时TFPI活性高于对照组（126.9±34对92.0±13%，p<0.005），血糖控制良好后降低（p<0.005），与对照组相似（91.0±16.5%）。TFPI下降与HbA1c的变化相关（p<0.05；r = 0.54）。基线时TM水平显著高于对照组（42.3±9.1对29.00±10.9；p<0.005）且未改变。研究的其余参数在患者和对照组之间相似，血糖优化后也未改变。
血糖控制优化可使TFPI升高的活性恢复正常，但不能使无慢性并发症的控制不佳的I型糖尿病患者中观察到的较高TM水平恢复正常。
