Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Diabet Med. 2014 Apr;31(4):462-5. doi: 10.1111/dme.12387. Epub 2014 Jan 17.
To examine the association between changes in procoagulants (fibrinogen factors VII and VIII and von Willebrand factor) and the risk of insulin resistance.
Using data from the Coronary Artery Risk Development in Young Adults study, we followed 2398 black and white adults without diabetes, aged 25-37 years at year 7, to year 20. Levels of fibrinogen factors VII and VIII and von Willebrand factor were divided in tertiles (low/middle/high) at years 7 and 20 and four groups reflecting changes were defined: 'low' (low at years 7 and 20), 'stable' (low/middle at years 7 and 20, but not both low at years 7 and 20), 'high' (high at year 7 and low/middle at year 20; or low/middle at year 7 and high at year 20) and 'highest' (high at years 7 and 20). Linear regression models were used to evaluate 13-year changes (year 20-year 7) in fibrinogen level and factors VII, VIII and von Willebrand change groups in relation to insulin resistance measures.
Homeostasis model assessment of insulin resistance (year 20) and changes in log homeostasis model assessment of insulin resistance (year 20-year 7) were significantly associated with the 13-year increase in fibrinogen (P < 0.001). Compared with participants in the low group, those in the high group had significantly higher levels of homeostasis model assessment of insulin resistance (year 20) and changes in homeostasis model assessment of insulin resistance (year 20-year 7) for fibrinogen factor VII and von Willebrand factor (P < 0.017). No significant associations were observed between fibrinogen VIII and insulin resistance measures.
An increase in fibrinogen level and persistently high levels of factor VII and von Willebrand factor are significantly associated with increased risk of insulin resistance. These findings provide new insight into the mechanisms to explain the heightened risk for thrombosis in adults with insulin resistance/diabetes.
研究促凝物质（纤维蛋白原、因子 VII 和 VIII 及血管性血友病因子）的变化与胰岛素抵抗风险之间的关系。
利用来自“年轻成人冠状动脉风险发展研究”的数据，我们对 2398 名年龄 25-37 岁、无糖尿病的黑人和白人进行了随访，随访时间从第 7 年至第 20 年。第 7 年和第 20 年时，纤维蛋白原、因子 VII 和 VIII 及血管性血友病因子的水平被分为三分位（低/中/高），根据变化情况将其定义为 4 组：“低”（第 7 年和第 20 年均低）、“稳定”（第 7 年时低/中，第 20 年时低/中，但第 7 年和第 20 年均非低值）、“高”（第 7 年时高，第 20 年时低/中；或第 7 年时低/中，第 20 年时高）和“最高”（第 7 年和第 20 年均高）。采用线性回归模型评估纤维蛋白原水平和因子 VII、VIII 及血管性血友病因子变化组在第 13 年（第 20 年-第 7 年）的变化与胰岛素抵抗指标之间的关系。
胰岛素抵抗的稳态模型评估（第 20 年）和胰岛素抵抗的稳态模型评估变化（第 20 年-第 7 年）与纤维蛋白原水平的 13 年增加显著相关（P<0.001）。与低组参与者相比，高组参与者的纤维蛋白原因子 VII 和血管性血友病因子的胰岛素抵抗的稳态模型评估（第 20 年）和胰岛素抵抗的稳态模型评估变化（第 20 年-第 7 年）显著升高（P<0.017）。纤维蛋白原 VIII 与胰岛素抵抗指标之间未见显著相关性。
纤维蛋白原水平升高和因子 VII 及血管性血友病因子持续升高与胰岛素抵抗风险增加显著相关。这些发现为解释成年人中胰岛素抵抗/糖尿病患者血栓形成风险增加的机制提供了新的见解。
