Aso Y, Fujiwara Y, Tayama K, Takanashi K, Inukai T, Takemura Y
Department of Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
Exp Clin Endocrinol Diabetes. 2001;109(4):210-6. doi: 10.1055/s-2001-15108.
Endothelial dysfunction plays a pivotal role in the initial stage of atherosclerosis. Insulin resistance is associated with accelerated atherosclerosis, especially coronary heart disease. To elucidate the relationship between endothelial dysfunction and insulin resistance or insulin resistance syndrome in patients with type 2 diabetes, we investigated the correlation between plasma soluble thrombomodulin (TM) and von Willebrand factor (vWF), measures of endothelial dysfunction, and the degree of insulin resistance evaluated by homeostasis assessment models of insulin resistance (HOMA-IR), or variables of insulin resistance syndrome. We studied 53 patients with type 2 diabetes, 23 treated with diet alone and 30 treated with sulfonylureas, who had normal renal function. The plasma soluble TM concentrations were highly correlated with HOMA-IR (r=0.64, p<0.0001), the plasma insulin (r=0.72, p<0.0001), the systolic blood pressure (r=0.45, p=0.0005), and the plasma fibrinogen (r=0.43, p=0.0018), while they were inversely correlated with the serum HDL cholesterol concentrations (r=-0.27, p=0.0344). The plasma vWF concentrations were positively correlated with HOMA-IR (r=0.35, p=0.0151) and the plasma fibrinogen (r=0.32, p=0.0203), but not with the plasma insulin, the systolic blood pressure or the HDL cholesterol concentrations. Furthermore, plasma TM, but not vWF, was positively correlated with total number of variables of insulin resistance syndrome (r=0.45, p=0.0005). These results indicate that endothelial dysfunction may be associated with the pathogenesis of insulin resistance syndrome as well as insulin resistance, and that the plasma TM might reflect endothelial damage better than the plasma vWF in the state of insulin resistance in patients with type 2 diabetes.
内皮功能障碍在动脉粥样硬化的初始阶段起着关键作用。胰岛素抵抗与动脉粥样硬化加速进展相关，尤其是冠心病。为了阐明2型糖尿病患者内皮功能障碍与胰岛素抵抗或胰岛素抵抗综合征之间的关系，我们研究了血浆可溶性血栓调节蛋白（TM）和血管性血友病因子（vWF）（内皮功能障碍的指标）与通过胰岛素抵抗稳态评估模型（HOMA-IR）评估的胰岛素抵抗程度或胰岛素抵抗综合征变量之间的相关性。我们研究了53例肾功能正常的2型糖尿病患者，其中23例仅接受饮食治疗，30例接受磺脲类药物治疗。血浆可溶性TM浓度与HOMA-IR（r=0.64，p<0.0001）、血浆胰岛素（r=0.72，p<0.0001）、收缩压（r=0.45，p=0.0005）和血浆纤维蛋白原（r=0.43，p=0.0018）高度相关，而与血清高密度脂蛋白胆固醇浓度呈负相关（r=-0.27，p=0.0344）。血浆vWF浓度与HOMA-IR（r=0.35，p=0.0151）和血浆纤维蛋白原（r=0.32，p=0.0203）呈正相关，但与血浆胰岛素、收缩压或高密度脂蛋白胆固醇浓度无关。此外，血浆TM而非vWF与胰岛素抵抗综合征变量总数呈正相关（r=0.45，p=0.0005）。这些结果表明，内皮功能障碍可能与胰岛素抵抗综合征以及胰岛素抵抗的发病机制相关，并且在2型糖尿病患者胰岛素抵抗状态下，血浆TM可能比血浆vWF更能反映内皮损伤。
