[2型糖尿病患者的慢性周围动脉闭塞性疾病、血小板糖蛋白GPIIb-IIIa和GP Ib-IX、血浆血管性血友病因子及血浆纤维蛋白原浓度]

[Chronic peripheral arterial occlusive disease, platelet glycoproteins GPIIb-IIIa and GP Ib-IX, plasma von Willebrand factor and plasma fibrinogen concentrations in patients with type 2 diabetes mellitus].

作者信息

Gosk-Bierska I, Adamiec R, Doskocz W, Ciosek W

机构信息

Katedra i Klinika Angiologii AM we Wrocławiu.

出版信息

Pol Arch Med Wewn. 2000 Mar-Apr;103(3-4):139-45.

PMID:11236240

Abstract

Diabetes mellitus (DM) type 2 is a very strong risk factor for atherosclerosis. The final event of atherosclerosis is the vessels occlusion by platelet riche thrombus. Platelets adhesion and aggregation is mediated by interaction between platelets glycoproteins: GPIb-IX, GPIIb-IIIa and adhesive proteins: von Willebrand factor or fibrinogen. The expression of platelets GPIb-IX, GPIIb-IIIa, plasma vWF, fibrinogen concentrations were evaluated in 40 patients with diabetes type 2 (22 patients with PAOD stage II and IV according to Fontain, 18 diabetics without paod) and 32 healthy individuals. The expression of platelets glycoproteins GPIIb-IIIa and GPIb-IX was estimated by ELISA using monoclonal antibody against GPIIb-IIIa (CD41a) and GPIb-IX (CD 42a Immunotech). Plasma vWf (189.7 +/- 53.6%), fibrinogen (4.5 +/- +/- 1.3 g/l) level and expression of platelets GPIb-IX (63.2 +/- 19.6% in platelets concentration 125,000/mm3, 104.5 +/- 28.1% in platelets concentrations 250,000/mm3) and GPIIb-IIIa 50.8 +/- 10.1% in platelets concentrations 125,000/mm3, 95.3 +/- 21.3% in platelets concentrations 250,000/mm3 were statistically higher in patients with diabetes type 2 than in controls (vWf: 94.9 +/- 27.1%, fibrinogen: 2.8 +/- 0.4 g/l, GPIb-IX in platelets concentration 125,000/mm3: 43.8 +/- 9.3%, in concentration 250,000/mm3: 83.9 +/- 18.3%, GPIIb-IIIa in platelets concentration 125,000/mm3: 33.7 +/- 10.1%, in platelets concentration 250,000/mm3: 63.2 +/- 15.4%). We found significant correlation between the expression of GPIIb-IIIa, GPIb-IIIa, GPIb-IX and plasma adhesive proteins: vWF, fibrinogen in controls and both subgroups of diabetic patients. The correlation between plasma vWF and fibrinogen level and degree of arterial insufficiency in diabetic patients was also found. We can assume that higher vWf, fibrinogen plasma level in diabetic patients with and without PAOD could account for high expression of platelets GPIIb-IIIa and GPIb-IX.

摘要

2型糖尿病（DM）是动脉粥样硬化的一个非常重要的危险因素。动脉粥样硬化的最终事件是富含血小板的血栓阻塞血管。血小板的黏附和聚集是由血小板糖蛋白（GPIb-IX、GPIIb-IIIa）与黏附蛋白（血管性血友病因子或纤维蛋白原）之间的相互作用介导的。对40例2型糖尿病患者（根据Fontain分级，22例为II期和IV期外周动脉疾病患者，18例无外周动脉疾病的糖尿病患者）和32名健康个体的血小板GPIb-IX、GPIIb-IIIa、血浆血管性血友病因子（vWF）、纤维蛋白原浓度进行了评估。采用针对GPIIb-IIIa（CD41a）和GPIb-IX（CD 42a Immunotech）的单克隆抗体，通过酶联免疫吸附测定（ELISA）法评估血小板糖蛋白GPIIb-IIIa和GPIb-IX的表达。2型糖尿病患者的血浆vWF（189.7±53.6%）、纤维蛋白原（4.5±1.3 g/l）水平以及血小板GPIb-IX（血小板浓度为125,000/mm3时为63.2±19.6%，血小板浓度为250,000/mm3时为104.5±28.1%）和GPIIb-IIIa（血小板浓度为125,000/mm3时为50.8±10.1%，血小板浓度为250,000/mm3时为95.3±21.3%）的表达在统计学上均高于对照组（vWF：94.9±27.1%，纤维蛋白原：2.8±0.4 g/l，血小板浓度为125,000/mm3时GPIb-IX：43.8±9.3%，血小板浓度为250,000/mm3时为83.9±18.3%，血小板浓度为125,000/mm3时GPIIb-IIIa：33.7±10.1%，血小板浓度为250,000/mm3时为63.2±15.4%）。我们发现，在对照组以及糖尿病患者的两个亚组中，GPIIb-IIIa、GPIb-IIIa、GPIb-IX的表达与血浆黏附蛋白vWF、纤维蛋白原之间存在显著相关性。还发现了糖尿病患者血浆vWF和纤维蛋白原水平与动脉供血不足程度之间的相关性。我们可以推测，无论有无外周动脉疾病，糖尿病患者较高的血浆vWF和纤维蛋白原水平可能是血小板GPIIb-IIIa和GPIb-IX高表达的原因。