Juhan-Vague I, Vague P
Laboratoire d'Hématologie, CHU Timone, Marseille, France.
Am J Obstet Gynecol. 1990 Jul;163(1 Pt 2):313-5. doi: 10.1016/0002-9378(90)90573-p.
Metabolic diseases, such as obesity, impaired glucose tolerance, type I and type II diabetes, hypercholesterolemia, and hypertriglyceridemia, are among the main risk factors for the development of atherothrombosis. Various abnormalities of the hemostatic system (platelet hyperaggregability, hypercoagulability, and hypofibrinolysis) have been described in all these situations. The individual effect of each of these disease on the hemostatic system is difficult to evaluate because these states are often associated in the same patient and the treatment of one can benefit the others. Therefore it may be queried if a common abnormality of these pathologic states might explain their impact on the cardiovascular system. We have been interested by hyperinsulinemia, which is observed in obesity, impaired glucose tolerance, type II diabetes, and hypertriglyceridemia, and we have shown a very strong correlation between plasma insulin, body mass index, triglyceride levels, and one of the main inhibitors of the fibrinolytic system, plasminogen activator inhibitor-1. Partial correlation analysis showed that only the correlation between insulin and plasminogen activator inhibitor-1 was independent. Therefore a high plasma insulin level could be responsible for elevated levels of plasminogen activator inhibitor-1, which by inducing an hypofibrinolysis, could play a role in the deposition of fibrin and the development of atherothrombosis. The description of some interrelations between metabolic diseases and hemostasis is satisfactory but does not exclude specific effects of these diseases on hemostasis, such as glycation of the coagulation and fibrinolytic factors in diabetes or toxic action of lipoprotein on endothelial cells in hyperlipoproteinemia.
代谢性疾病，如肥胖症、糖耐量受损、I型和II型糖尿病、高胆固醇血症和高甘油三酯血症，是动脉粥样硬化血栓形成的主要危险因素。在所有这些情况下，均已描述了止血系统的各种异常（血小板高聚集性、高凝状态和纤溶活性降低）。由于这些状态在同一患者中常常同时存在，且一种疾病的治疗可能会使其他疾病受益，因此很难评估每种疾病对止血系统的单独影响。因此，人们可能会质疑，这些病理状态的共同异常是否可以解释它们对心血管系统的影响。我们一直关注高胰岛素血症，它在肥胖症、糖耐量受损、II型糖尿病和高甘油三酯血症中均有观察到，并且我们已经发现血浆胰岛素、体重指数、甘油三酯水平与纤维蛋白溶解系统的主要抑制剂之一纤溶酶原激活物抑制剂-1之间存在非常强的相关性。偏相关分析表明，只有胰岛素与纤溶酶原激活物抑制剂-1之间的相关性是独立的。因此，高血浆胰岛素水平可能导致纤溶酶原激活物抑制剂-1水平升高，通过诱导纤溶活性降低，可能在纤维蛋白沉积和动脉粥样硬化血栓形成中发挥作用。对代谢性疾病与止血之间一些相互关系的描述是令人满意的，但并不排除这些疾病对止血的特定影响，如糖尿病中凝血和纤溶因子的糖基化或高脂蛋白血症中脂蛋白对内皮细胞的毒性作用。
