Bronisz Agata, Rosc Danuta, Bronisz Marek, Szymanski Wieslaw, Junik Roman
Department of Endocrinology and Diabetology, The L. Rydygier Medical University, Bydgoszcz, Poland.
Med Sci Monit. 2008 Nov;14(11):CR574-9.
Many studies have reported changes in the hemostatic system in patients with type 1 diabetes in whom coagulation processes predominate over fibrinolytic activity. The aim of this study was to assess some of the hemostatic variables during pregnancy women with in type 1 diabetes.
MATERIAL/METHODS: The current study included 31 pregnant diabetic women and 24 healthy pregnant women. At 12, 24, and 36 weeks of gestation, we determined blood concentrations of the following: platelet count, fibrinogen, tissue plasminogen activator antigen, and plasminogen activator inhibitor-1.
When we compared pregnant diabetic women in the third trimester with those in the first trimester, we observed a statistically significant decrease in the platelet count (172.0+/-9.0 vs 200.6+/-9.8 G/L, P<0.05) and a statistically significant increase in the levels of fibrinogen (3.5+/-0.2 vs 2.9+/-0.2 g/L, P<0.05), tissue plasminogen activator antigen (14.9+/-2.2 vs 4.7+/-0.6 ng/mL, P<0.001), and plasminogen activator inhibitor-1 (17.2+/-2.8 vs 4.0+/-1.0 IU/mL, P<0.001). Similar fibrinogen, tissue plasminogen activator: A, and plasminogen activator inhibitor-1 changes were observed in pregnant women (3.8+/-0.3 vs 2.9+/-0.2 g/L, P<0.05; 7.7+/-0.9 vs 5.2+/-0.3 ng/mL, P<0.05; and 17.6+/-2.1 vs 5.1+/-1.1 IU/mL, P<0.05, respectively). Tissue plasminogen activator antigen was the only variable to significantly increase during the third trimester in pregnant diabetic women with microangiopathy compared with women without microangiopathy (21.0+/-3.2 vs 8.4+/-1.7 ng/mL, P<0.01).
(1) In patients with type 1 diabetes without microangiopathy and with good metabolic control, fibrinogen and tissue plasminogen activator antigen concentrations and changes in the activity of plasminogen activator inhibitor-1 are similar to those found in patients with a normal pregnancy; (2) the marked decrease in platelet count in patients with type 1 diabetes during pregnancy may be an additional source of plasminogen activator inhibitor-1; and (3) during pregnancy, diabetic microangiopathy leads to a greater increase of tissue plasminogen activator antigen concentration as a marker of endothelial cell injury.
许多研究报道了1型糖尿病患者止血系统的变化，其中凝血过程比纤溶活性更为突出。本研究的目的是评估1型糖尿病孕妇的一些止血变量。
材料/方法：本研究纳入了31名糖尿病孕妇和24名健康孕妇。在妊娠12、24和36周时，我们测定了以下血液浓度：血小板计数、纤维蛋白原、组织纤溶酶原激活物抗原和纤溶酶原激活物抑制剂-1。
当我们将妊娠晚期的糖尿病孕妇与妊娠早期的孕妇进行比较时，我们观察到血小板计数有统计学意义的下降（172.0±9.0 vs 200.6±9.8 G/L，P<0.05），纤维蛋白原水平、组织纤溶酶原激活物抗原和纤溶酶原激活物抑制剂-1有统计学意义的升高（3.5±0.2 vs 2.9±0.2 g/L，P<0.05；14.9±2.2 vs 4.7±0.6 ng/mL，P<0.001；17.2±2.8 vs 4.0±1.0 IU/mL，P<0.001）。在健康孕妇中也观察到了类似的纤维蛋白原、组织纤溶酶原激活物抗原和纤溶酶原激活物抑制剂-1的变化（分别为3.8±0.3 vs 2.9±0.2 g/L，P<0.05；7.7±0.9 vs 5.2±0.3 ng/mL，P<0.05；17.6±2.1 vs 5.1±1.1 IU/mL，P<0.05）。与无微血管病变的孕妇相比，有微血管病变的1型糖尿病孕妇在妊娠晚期组织纤溶酶原激活物抗原是唯一显著升高的变量（21.0±3.2 vs 8.4±1.7 ng/mL，P<0.01）。
（1）在无微血管病变且代谢控制良好的1型糖尿病患者中，纤维蛋白原和组织纤溶酶原激活物抗原浓度以及纤溶酶原激活物抑制剂-1活性的变化与正常妊娠患者相似；（2）1型糖尿病患者在妊娠期间血小板计数的显著下降可能是纤溶酶原激活物抑制剂-1的另一个来源；（3）在妊娠期间，糖尿病微血管病变导致组织纤溶酶原激活物抗原浓度作为内皮细胞损伤标志物的更大幅度升高。
