Hockaday T D
Metabolism. 1979 Apr;28(4 Suppl 1):415-22. doi: 10.1016/0026-0495(79)90048-9.
All agree on altered platelet function in vitro (and increasingly in vivo) in diabetics of substantial duration and/or with clinical evidence of angiopathy. However, a platelet abnormality earlier in the disease remains uncertain. Three sets of data from Oxford will be reviewed: (1) Observations of Honour on platelet aggregation at sites of minimal injury within blood vessels of anesthetized rabbits, with greater sensitivity to superfused ADP when hyperglycemia has followed alloxan only days previously. This increased aggregatability (not hyperglycemia determined) is reversed by a few days of insulin treatment or by dipyrimadole (alone or with synergistic acetyl salicylic acid): (2) Beta-thromboglobulin is released from platelets and is increased in venesected blood from diabetics after a standardized procedure (no prostaglandin E1 in anticoagulant) with final radioimmunoassay. Results in diabetics after surgery, etc., will also be presented, and (3) in a prospective study of newly-diagnosed, mostly maturity-onset type diabetics, an increase in plasma fibrinogen (thrombin coagulation of plasma, controlled against normals) was observed during the first 3 yr, largely due to males treated with sulfonylureas; decreases in platelet count and in prothrombin concentration were also statistically significant.
所有研究人员都认同，病程较长和/或有血管病变临床证据的糖尿病患者，其血小板功能在体外（以及越来越多的在体内）会发生改变。然而，在疾病早期是否存在血小板异常仍不明确。本文将回顾来自牛津大学的三组数据：（1）霍诺尔对麻醉兔血管内微小损伤部位血小板聚集情况的观察，结果显示，若在四氧嘧啶致高血糖仅数天后，血小板对灌注的二磷酸腺苷（ADP）更为敏感。这种聚集性增加（并非由高血糖决定）可通过数天的胰岛素治疗或双嘧达莫（单独使用或与协同的乙酰水杨酸联合使用）得以逆转：（2）β-血小板球蛋白由血小板释放，在糖尿病患者经标准化程序（抗凝剂中不含前列腺素E1）采集的静脉血中，经最终放射免疫测定，其含量会升高。本文还将展示糖尿病患者术后等情况下的结果，以及（3）在一项对新诊断的、大多为成年发病型糖尿病患者的前瞻性研究中，观察到在最初3年里，血浆纤维蛋白原（血浆凝血酶凝固法，与正常人对照）增加，这主要是由于使用磺脲类药物治疗的男性患者；血小板计数和凝血酶原浓度降低也具有统计学意义。
